140A One-Year Audit of the Use of Intermittent Pneumatic Compression Devices (IPC) Post Stroke in a Teaching Hospital

Abstract

Background: Deep vein thrombosis (DVT) is common in patients admitted to hospital with an acute stroke and may result in pulmonary emboli (PE). It is estimated that approximately 20% of immobile stroke patients will develop a DVT and 10% a PE. Following the CLOTS 3 Trial, IPC's should be considered for venous thromboembolism prophylaxis for acute stroke patients according to the RCP National Clinical Guidelines for Stroke (2016)(1). Methods: All patients admitted with an acute stroke from January to December 2016 were included in this audit. The guidelines (2016) advocate the use of IPC stockings within 3 days of admission to hospital and should be continuous for 30 days or until the patient is mobile or discharged. We particularly advocated the use of IPC in haemorrhagic immobile patients where antiplatelet therapy is contraindicated. Results: 383 patients (mean age 74) were admitted with stroke in 2016 of which 64 (17%) were haemorrhage, 319 (83%) were ischaemic. 50 patients admitted to the stroke unit were prescribed IPC stockings of which 35 patients (70%) tolerated well. 7 patients (14%) did not tolerate and a decision was made to remove the IPC stockings on a further 6 patients (12%) due to palliation. Of the 383 patients, 3 DVT's (0.8%) and 2 PE's (0.5%) were confirmed through ultrasound and CT imaging. Conclusion: Whilst the numbers in this audit were small and revealed a low prevalence of DVT and PE, this data could be interpreted, that IPC stockings combined with early mobilisation, adequate hydration and antiplatelet therapy are as effective in preventing DVT's and PE's in ischaemic strokes or perhaps there is a large proportion of patients that are being missed due to the severity of their stroke and die before a diagnosis is made. More research is needed and we will continue to monitor this data and re-audit in the future.