Weren’t able to make the last Journal Club on VTE? Here’s a recap.

Weren’t able to make the last Journal Club on VTE? Here’s a recap.

During the January 20th Journal Club meeting, Laura Norton, MSN, RN, AAMC’s Stroke Coordinator, presented practice guidelines related to venous thromboembolism (VTE) prophylaxis in the acute stroke patient. VTE is a condition that includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is the formation of a blood clot in a deep vein—usually in the leg or pelvic veins. The most serious complication of a DVT is that the clot could dislodge and travel to the lungs, becoming a PE.

If you weren’t able to attend, here are the key points. (Read the article here: Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association.)

Stroke and VTE statistics:

  • 10% of deaths after stroke due to PE
  • PE found in <2.5% of patients during first week in stroke unit
  • PE most likely to occur in first 3 months post stroke
  • PE arise from venous thrombi in paralyzed lower extremity or pelvis
  • VTE slows recovery and rehabilitation
  • Highest risk for VTE immobilized and older patients with severe stroke

2013 Stroke Clinical Practice Guidelines:

  • Early mobilization of less severely affected patients and measures to prevent subacute complications of stroke are recommended (Class I; Level of Evidence C)
  • Subcutaneous administration of anticoagulants is recommended for treatment of immobilized patients to prevent VTE (Class I; Level of Evidence A)
  • The use of intermittent external compression devices is reasonable for treatment of patients who cannot receive anticoagulants (Class IIa; Level of Evidence B)

Reminders:

  • VTE prophylaxis (pharmacologic, mechanical, or both) must be started by hospital day #2 (day of admission is day #1).
  • If VTE prophylaxis is not started on day #2 then a contraindication must be clearly documented (VTE prophylaxis by day #2 is a core measure.)
  • Clearly document when SCDs are on or off.
  • If the patient refuses SCDs, clearly document that an explanation was provided to the patient about the rationale for SCDs and the risk of VTE.
  • Clearly document the patient’s ambulation ability, frequency, and distance.  

-Cathaleen Ley, Ph.D, RN

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