Prevention of venous thrombosis in patients with acute intracerebral hemorrhage

Groupe d'Etude de la Thrombose de Bretagne Occidentale, Equipe d'Accueil 3878, Cavale Blanche Hospital, Brest, France.
Neurology (Impact Factor: 8.29). 10/2005; 65(6):865-9. DOI: 10.1212/01.wnl.0000176073.80532.a2
Source: PubMed


To assess intermittent pneumatic compression (IPC) in the prevention of venous thromboembolism (VTE).
The authors randomly allocated patients with a documented intracerebral hemorrhage (ICH) to elastic stockings (ES) alone or combined with IPC. The primary outcome was a combined criteria assessed at day 10: a symptomatic and well-documented VTE, or a death arising before day 10 and related to pulmonary embolism (PE), or an asymptomatic deep vein thrombosis (DVT) of the lower limbs detected by compression ultrasonography (CUS). Outcome assessment was blinded.
One hundred fifty-one patients were randomized; 133 (88%) patients were evaluated at day 10. No clinical suspicion of VTE arose before day 10. Fourteen patients died before having a CUS but no death was definitely related to PE. Fourteen asymptomatic DVT were detected by CUS: three (4.7%) in the ES + IPC group (all distal) and 11 (15.9%) in the ES group (three proximal and eight distal). ES combined with IPC is associated with a reduced risk of asymptomatic DVT compared to ES alone: relative risk, 0.29 (95% CI 0.08 to 1.00).
Asymptomatic deep vein thrombosis (DVT) was detected at day 10 in 15.9% of patients wearing elastic stockings alone. Intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT for patients with intracerebral hemorrhage.

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    • "[13]. One of the studies in this meta-analysis has addressed the benefits of intermittent pneumatic compression in preventing DVT in 155 patients with intracerebral hemorrhage [14]. The combination of elastic stockings and intermittent pneumatic compression significantly decreased the occurrence of asymptomatic DVT, as compared with the use of elastic stockings alone (relative risk, 0.29; 95% CI, 0.08–1.00) "
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    ABSTRACT: Opinion statement The risk of deep vein thrombosis (DVT) after stroke is increased in patients with restricted mobility, a previous history of DVT, dehydration, or comorbidities such as malignant diseases or clotting disorders. Patients with an increased risk of DVT should receive prophylactic treatment. To reduce the chance of DVT, patients should be mobilized as soon as possible and should be kept well hydrated. Anti-embolism stockings cannot be recommended, because they have been demonstrated not useful for preventing DVT or pulmonary embolism in patients with stroke, and they are associated with a significantly increased risk of skin breaks. The usefulness of intermittent pneumatic compression is currently under study in a randomized clinical trial. Treatment with subcutaneously administered low-dose unfractionated heparin is preferred to unfractionated heparin and may be considered in patients with ischemic stroke if the risk of DVT is estimated to be higher than the risk of hemorrhagic complications. Aspirin may also be effective for patients with ischemic stroke who have contraindications to anticoagulants, although direct comparisons with anticoagulants are not available. In patients with intracerebral hemorrhage, low-dose subcutaneous low-molecular-weight heparin is probably safe after documentation of cessation of active bleeding, and may be considered on an individual basis after 3 to 4 days from stroke onset.
    Current Treatment Options in Neurology 09/2011; 13(6):629-35. DOI:10.1007/s11940-011-0147-4 · 1.94 Impact Factor
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    • "뿐만 아니라 신경외과 환자는 수술 후 출혈 위험에 대한 공포로 항 응고제요법이 제한되어(Choi & Park, 2006) 심부정맥 혈전증 발생 위험률을 더 증가시킨다. 따라서 뇌수술 환자는 혈류속도를 높여 정맥귀환을 증진시키는 방법이 유일한 예방법으로 적용되고 있다(Lacut et al., 2005 "
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    ABSTRACT: This study was done to evaluate the mean venous velocity (MVV) response with knee and thigh length compression stockings (CS) versus intermittent pneumatic compression (IPC) devices in immobile patients with brain injuries. We carried out a randomized controlled study. We analyzed both legs of a randomly chosen sample of 43 patients assigned to one of 4 groups (86 legs). The patients were sequentially hospitalized in the intensive care unit (ICU) in "S hospital" from November 2005 to December 2006. The base line and augmented venous velocity was measured at the level of the common femoral vein. We applied leg compression 42 times over 7 days (for 2 hours at a time at 2 hour intervals). There was a statistical difference among the 4 groups. The difference for the "IPC" group was more significant than the "CS" group. These results indicate that the application of IPC can be considered as an effective method to prevent deep vein thrombosis for immobile patients with brain injury.
    Journal of Korean Academy of Nursing 05/2009; 39(2):288-97. DOI:10.4040/jkan.2009.39.2.288 · 0.38 Impact Factor
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    • "Immobilized state due to limb paresis predisposes ICH patients for deep vein thrombosis and pulmonary embolism. Intermittent pneumatic compression devices and elastic stockings should be placed on admission (Lacut et al 2005). A small prospective trial by Boeer and colleagues using low-dose heparin on hospital day 2 to prevent thromboebolic complications in ICH patients significantly lowered the incidence of pulmonary embolism and no increase in rebleeding was observed (Boeer et al 1991). "
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    ABSTRACT: Currently, intracerebral hemorrhage (ICH) has the highest mortality rate of all stroke subtypes (Counsell et al 1995; Qureshi et al 2005). Hematoma growth is a principal cause of early neurological deterioration. Prospective and retrospective studies indicate that up to 38% hematoma expansion is noted within three hours of ICH onset and that hematoma volume is an important predictor of 30-day mortality (Brott et al 1997; Qureshi et al 2005). This article will review current standard of care measures for ICH patients and new research directed at early hemostatic therapy and minimally invasive surgery.
    Vascular Health and Risk Management 02/2007; 3(5):701-9.
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