Venous Thromboembolism Prevention in Acute Ischemic Stroke

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a frequent and potentially fatal complication of acute ischemic stroke. Factors such as immobility, endothelial injury and a prothrombotic state contribute to clot formation in the lower limbs and subsequent migration to the pulmonary circulation. Prevention strategies centre on pharmacological and mechanical thromboprophylaxis initiated early in hospital care and tailored to individual risk. Low-dose anticoagulants, most commonly low molecular weight heparin, reduce DVT incidence but require balancing against haemorrhagic risk. Mechanical measures, notably intermittent pneumatic compression (IPC), complement drug regimens and may be employed when anticoagulation is contraindicated. Recent advances have refined risk stratification through clinical scores and biomarkers, enabling targeted prophylaxis. Emerging evidence highlights the importance of systematic screening, patient selection for prophylactic modalities and integration of novel prediction tools to optimise outcomes.

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Venous Thromboembolism Prevention in Acute Ischemic Stroke publication trend

The graph below shows the total number of articles in venous thromboembolism prevention in acute ischemic stroke across all publications each year (not limited to Nature Index journals).

Technical terms

Venous thromboembolism (VTE): A condition in which blood clots form in the venous system, encompassing DVT and PE.

Deep vein thrombosis (DVT): Formation of a blood clot in a deep vein, typically of the legs, which can impede venous return and risk embolisation.

Pulmonary embolism (PE): Obstruction of pulmonary arteries by emboli, most often dislodged blood clots originating from DVT, leading to impaired gas exchange and hemodynamic compromise.

Thromboprophylaxis: Preventive strategies, pharmacological or mechanical, aimed at reducing the risk of VTE in high-risk patients.

Intermittent pneumatic compression (IPC): A mechanical method that applies cyclic pressure to the limbs to promote venous flow and prevent clot formation.

D-dimer: A degradation product of cross-linked fibrin used as a biomarker to detect active clot formation and breakdown.

Nomogram: A graphical calculation tool that integrates multiple predictors to estimate the probability of a clinical event for an individual patient.

References

1. Effect of intermittent pneumatic compression on disability, living circumstances, quality of life, and hospital costs after stroke: secondary analyses from CLOTS 3, a randomised trial. The Lancet Neurology (2014).
2. Deep Vein Thrombosis in Acute Stroke - A Systemic Review of the Literature. Cureus (2017).
3. Risk factors and predictors for venous thromboembolism in people with ischemic stroke: A systematic review. Journal of Thrombosis and Haemostasis (2022).
4. Individualized predictions of early isolated distal deep vein thrombosis in patients with acute ischemic stroke: a retrospective study. BMC Geriatrics (2021).
5. Risk factors for lower extremity deep vein thrombosis in acute stroke patients following endovascular thrombectomy: a retrospective cohort study. Frontiers in Neurology (2023).