Thromboprophylaxis with heparin or LMWH is acceptable for VTE prevention in stroke despite bleeding risks, whereas graduated compression stockings increase adverse events and are not recommended.
Pharmacological prophylaxis with unfractionated heparin, LMWH, or danaparoid is acceptable for VTE prevention in stroke patients, but graduated compression stockings are not recommended due to adverse events.
Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, is a potentially fatal but preventable complication of stroke. Reported rates of VTE after stroke have decreased over the last four decades, possibly due to the implementation of stroke units, early mobilization and hydration, and increased early use of antiplatelets. Additional means of thromboprophylaxis in stroke include mechanical methods (ie, compression stockings) to prevent venous stasis and medical therapy including antiplatelets, heparins, and heparinoids. Risk of VTE must be balanced by potential risk of hemorrhagic complications from pharmacotherapy. Unfractionated heparin, low-molecular-weight heparin (LMWH), and danaparoid are acceptable options for chemoprophylaxis though none have shown superior efficacy for VTE prevention without an associated increase in major hemorrhage. The efficacy and timing of pharmacological thromboprophylaxis in hemorrhagic stroke are not well defined. Graduated compression stockings are associated with an increased rate of adverse events and are not recommended and intermittent pneumatic compression stockings require further investigation.
Field et al. (Wed,) conducted a review in Stroke. Thromboprophylaxis (pharmacological and mechanical) was evaluated. Thromboprophylaxis with heparin or LMWH is acceptable for VTE prevention in stroke despite bleeding risks, whereas graduated compression stockings increase adverse events and are not recommended.