A recently published study looked at the effect of the mandatory VTE risk assessment that has been in place in England since 2010. This shows a significant reduction both in total HAT events but also when expressed as a percentage of total annual admissions. In addition the number of events associated with inadequate prevention has also significantly reduced over the same period. The most recent data however suggests there has been a plateauing of number of VTE events associated with hospital stay acknowledging not all VTE events can be prevented.
The link is available at http://openheart.bmj.com/content/4/2/e000653
Current UK practice for DVT prophylaxis in acute stroke patients is based upon data from the CLOTS 3 study and usually comprises of Intermittent Pneumatic Compression (IPC) or a prophylactic-dose of Low Molecular Weight Heparin (LMWH) when the bleed risk is reduced1. However, regardless of these interventions, a small group of patients remain contraindicated to these therapies leaving them exposed to developing a DVT or PE.
Firstkind Ltd, a UK based medical devices company, is working with an NHS Trust to introduce the innovative geko™ device into the acute stroke pathway, when patients are unsuitable for drug prophylaxis and/or contraindicated to IPC.
The geko™ is a battery powered, disposable, neuromuscular electrostimulation device designed to increase blood flow in the deep veins of the leg2. The geko™ gently stimulates the common peroneal nerve activating the calf and foot muscle pumps increasing venous, arterial and microcirculatory blood flow. The blood flow increase is equal to 60%3 of walking without a patient having to move or exert energy.
Patient compliance and the geko™ anti-stasis capability is being assessed through a prospective audit of clinical practice, covering patients who have been admitted for either ischemic or haemorrhagic stroke4. Patients unsuitable for VTE drug prophylaxis or contraindicated to IPC are being given the geko™ device.
Interim analysis highlights that the majority of high risk immobile acute stroke patients who could not tolerate IPC are able to tolerate the geko™. These patients would have not been treated as effectively otherwise, with the potential that geko™ will reduce the risk of morbidity and mortality in stroke patients. For more information on the geko™ device, click here: http://www.gekodevices.com/en-uk/
- NICE guidelines (CG92). Published date January 2010, update June 2015.
- Nicolaides, M Griffin, Measurement of blood flow in the deep veins of the lower limb using the geko™ neuromuscular electro-stimulation device. Journal of International Angiology August 2016-04.
- Tucker A, Maass A, Bain D, Chen LH, Azzam M, Dawson H, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. The International journal of angiology: official publication of the International College of Angiology, Inc. 2010 Spring; 19(1): e31-7.
- Stoke, prospective data on file, prospective April 2017, Firstkind.