The problems pertaining to the prophylaxis of venous thromboembolism following severe stroke

Abstract

Ключевые слова: инсульт, венозный тромбоз, тромбоэмболия легочной артерии, реанимация и интенсивная терапия. Objective. The objective of the present work was to reduce lethality associated with pulmonary thromboembolism (PTE) in the patients suffering stroke and hospitalized at the departments of resuscitation and intensive therapy. Material and methods. The study included 156 patients in the acute period of stroke (within 21 days after the onset) of different types (ischemic and hemorrhagic), severity, and localization (supra- and subtentorial). One group of the patients (n=123) were given the standard prophylactic treatment to prevent venous thromboembolism while the patients of the second group (n=33) were prescribed robotic-assisted mechanotherapy with the use of a special exercise machine. Results. Venous thromboembolism developed in 59 and 58% of the patients in groups 1 and 2, respectively, largely in the early period of stroke. Acute venous thrombosis was diagnosed in all patients; it was asymptomatic in the majority of the cases. The clinical course of the stroke was complicated by non-fatal pulmonary thromboembolism in 26% of the patients in the first group and in 15% of the cases in the second group. Fatal pulmonary embolism occurred only in 0.8% of the cases in the first group. The frequency of hemorrhagic complications in the patients given heparin therapy was estimated at 0.8%. Conclusion. The frequency of venous thromboembolism in the patients suffering severe stroke and hospitalized at the departments of resuscitation and intensive therapy remains rather high despite the prophylactic treatment including robotic-assisted mechanotherapy. At the same time, the frequency of non-fatal pulmonary thromboembolism decreased in the first group by a factor of 1.7 (from 46 to 26%) compared with the earlier reports. The three-fold reduction in the frequency of this condition (from 46 to 15%) was achieved with the use of robotic-assisted mechanotherapy in the second group. As a result the overall lethality from pulmonary thromboembolism was decreased and the hemorrhagic complication rate was reduced to a minimum.