WeMPiC protocol to prevent Deep Venous Thrombosis in patients with neurosurgical diseases

2020 ◽  
Vol 17 (1) ◽  
pp. 10-20
Author(s):  
Amit Thapa ◽  
Bidur KC ◽  
Bikram Shakya ◽  
Rupesh Chakradhar
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Lower Limbs ◽  
Sufficient Evidence ◽  
Patient Specific ◽  
Compression Stockings ◽  
Icu Stay ◽  
Compression Ultrasound ◽  
Neurosurgical Patients ◽  
Graduated Compression Stockings

Background: Deep Venous Thrombosis is a common yet difficult problem to prevent in neurosurgical patients. Recent trials did not find sufficient evidence to support use of graduated compression stockings, however we believe, this inefficiency may be due to the method of application which needs to be modified. We have been following a patient specific mechanical prophylaxis protocol, nicknamed WeMPiC. This study aims to evaluate the effectiveness of WeMPiC protocol. Methods: An observational cohort study was performed including consecutive patients admitted to neurosurgical ICU who were bedridden for >7 days between April 2014 and September 2017. We developed WeMPiC protocol of early weaning off, early mobilization, limb physiotherapy and alternate two hours on and off application of thigh length graduated compression stockings. Lower limbs compression ultrasound studies were performed on alternate days. Results: One hundred thirty-one patients were included in the study. Mean age of patients was 53.7+ 20.6 years. Of these patients, 52.7% had stroke (91% had hemorrhages), 32.1% had head injury and 7.6% each had spine problem and brain tumor each. five (3.8%) developed deep venous thrombosis on the 4th and 6th day of ICU stay, mainly in popliteal veins (2.3%) and femoral veins (1.5%). Deep venous thrombosis was associated with younger age (47 years, p=0.005), ICU stay (13 days, p=0.014), Wells’ score (4.6, p<0.0001) and Poor Glasgow Coma Score at presentation (9, p=0.004). Power of study calculated for the cohort incidence of 3.8% was 100%. Cost benefit of $336 with WeMPiC protocol was seen as compared to the Low molecular weight heparin prophylaxis over four weeks. Conclusions: Compared to incidence of 12.1% in CLOTS 3 trial among the unexposed patients, we report a risk reduction of 8.3% with WeMPiC protocol which is cost effective and highly applicable in resource constraint scenarios.

Impact of graduated compression stockings on the prevention of post-thrombotic syndrome - results of a randomized controlled trial

2014 ◽  
Vol 30 (8) ◽  
pp. 541-548 ◽  
Author(s):  
Arjun Jayaraj ◽  
Mark Meissner
Keyword(s):  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Severity Score ◽  
Scoring Systems ◽  
Clinical Severity ◽  
Compression Stockings ◽  
Post Thrombotic Syndrome ◽  
Clinical Severity Score ◽  
Venous Clinical Severity Score ◽  
Graduated Compression Stockings

Objective Post-thrombotic syndrome is a chronic complication of acute deep venous thrombosis in the lower extremity. The role of graduated compression stockings in the prevention of post-thrombotic syndrome has been studied with opinion being divided on the beneficial effects. We aim to answer this question with a randomized controlled study that uses multiple scoring instruments to assess post-thrombotic syndrome. Methods Sixty-nine consecutive patients with acute deep venous thrombosis diagnosed by duplex ultrasonography were randomized to treatment with graduated compression stockings or no graduated compression stockings. Venous Clinical Severity Score and Villalta-Prandoni Score, commonly used scoring systems, were used to appraise post-thrombotic syndrome at 3, 6, 12, 18, and 24 months following diagnosis of deep venous thrombosis. In both scoring systems, the individual either had post-thrombotic syndrome or no post-thrombotic syndrome. Cumulative incidence was computed using Kaplan–Meier analysis. Relative risk was assessed for age, obesity, varicose veins, and iliofemoral deep venous thrombosis. Results As measured by both Villalta-Prandoni Score and Venous Clinical Severity Score instruments, the graduated compression stockings group had a lower incidence of post-thrombotic syndrome compared to the control group, but only when one month was used as cut off time for the first diagnosis of post-thrombotic syndrome. When 6 or 12 months were used, there was no difference in the incidence of post-thrombotic syndrome between the two groups. The burden of post-thrombotic syndrome was significantly more when the Villalta-Prandoni Score instrument (∼75%) was used as compared to the Venous Clinical Severity Score instrument (∼30%) at 24 months’ follow-up. Obesity was the only statistically significant predictor for the development of post-thrombotic syndrome. Conclusion As assessed by both Villalta-Prandoni Score and Venous Clinical Severity Score instruments, use of graduated compression stockings does not reduce the incidence of post-thrombotic syndrome. There is a significant difference in the incidence post-thrombotic syndrome as detected by Villalta-Prandoni Score and Venous Clinical Severity Score instruments with incidence of post-thrombotic syndrome dependent on instrument and cut off time interval used to assess post-thrombotic syndrome. However, larger prospective studies are required to confirm these differences.

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