Treatment
ÎIn patients with acute stroke and restricted mobility, the ACCP suggests NOT using elastic compression stockings (2-B).
Remarks: ▶ Pharmacologic and mechanical prophylaxis should be initiated as early as possible and should be continued throughout the hospital stay or until the patient has regained mobility. Mechanical devices should be temporarily removed as often as needed to allow for early mobilization and screening for skin complications.
▶ Combining pharmacologic therapy with IPCDs may yield additional benefit in prevention of venous thromboembolisms (VTEs) compared with either method used alone.
Acute Ischemic Stroke or Transient Ischemic Attack
ÎIn patients with acute ischemic stroke or TIA, the ACCP recommends early (within 48 h) aspirin therapy at a dose of 160 to 325 mg over no aspirin therapy (1-A).
ÎIn patients with acute ischemic stroke or TIA, the ACCP recommends early (within 48 h) aspirin therapy with an initial dose of 160 to 325 mg over therapeutic parenteral anticoagulation (1-A).
Acute Primary Intracerebral Hemorrhage
ÎIn patients with acute primary ICH and restricted mobility, the ACCP suggests prophylactic-dose subcutaneous heparin (UFH or LMWH) started between days 2 and 4 or IPCDs over no prophylaxis (2-C).
ÎIn patients with acute primary ICH and restricted mobility, the ACCP suggests prophylactic-dose LMWH over prophylactic-dose UFH (2-B).
ÎIn patients with primary ICH and restricted mobility, the ACCP suggests NOT using elastic compression stockings (2-B).
Remarks: ▶ Patients who prefer to avoid a theoretically increased risk of rebleeding with heparin would favor mechanical prophylaxis with IPCDs over pharmacologic prophylaxis.
▶ Combining pharmacologic therapy with IPCDs may yield additional benefit in prevention of VTEs compared with either method used alone.
Cerebral Venous Sinus Thrombosis
ÎIn patients with cerebral venous sinus thrombosis, the ACCP suggests anticoagulation over no anticoagulant therapy during the acute and chronic phases (2-C).
