DVT/PE AFTER STROKE

In acute hemiparetic stroke, the up to 42% of patients develop DVT. The great majority of these are not clinically detectable. About 2% of patients develop PE. Full length graduated compression stockings have no effect on the prevalence of either DVT or PE. In this circumstance, they increase the risk of skin breaks, ulcers and blisters from 1% to 5 % (CLOTS study).

So, what to do after a stroke:
1. Don't do a carotid artery stent because the International Carotid Stenting Study suggests that this procedure is significantly more likely to result in stroke/MI/death within 3 months than carotid endarterectomy (8.4% vs 5.0% p=0.004).

2. Don't give UFH because the International Stroke Trial study suggested that UFH is no better than aspirin using death or recurrent stroke as an outcome at 6 months. Therefore, it is unknown whether LMH is safe for DVT prophylaxis, though it has been shown to be more effective than UFH at preventing DVT/PE after stroke, but at a risk of 0.8% of people getting an ICH. Unfortunately, there are no studies comparing UFH to placebo after stroke.


Shorr AF. Differences between low-molecular weight and unfractionated heparin for venous tromboembolism prevention following ischaemic stroke. Chest 2008; 133: 149-155

MIGRAINE

There is no therapeutic advantage to sumatriptan 100 mgs compared to 50 mg dose for severe migraine.


Only 15% of patients with migraine experience an aura.