Ambulation:
A key preventive measure is for patients to become ambulatory
as soon as possible. Venous stasis is due primarily to immobility.
Leg elevation:
Elevate heels above the heart to increase venous return
Elastic compression stockings:
Decreases venous stasis by applying the greatest compression
at the ankle and gradually decreasing compression as the
stocking approaches the thigh.
Once a stroke patient’s condition has been
evaluated, drug therapy becomes a very important issue.
In order to reduce the development of more thrombi, patients
are usually started on Heparin. Heparin, an agent used for
the prophylaxis and treatment of thromboembolic disorders,
works by catalyzing the action of antithrombin III inactivating
thrombin and preventing the conversion of fibrinogen to
fibrin. Heparin can be administered as an intermittent dose
of 5000 units SC every 8-12 hours or continuous infusion
calculated by a weight-based protocol.
The use of heparin, especially subcutaneously,
has been effective in prophylaxis therapy against thromboembolisms;
however, it is not economical to keep the patient in the
hospital for long periods of time to prophylaxis with heparin.
The development of Low Molecular Weight Heparins (LMWHs)
has enabled the stroke patient to decrease their hospital
stay but still get the proper treatment to avoid venous
thromboembolisms.
Low Molecular Weight Heparins
(LMWHs)
Use:
Prophylaxis of thromboembolic disorders (DVT with or without
pulmonary embolism)
MOA:
Fractions of heparin with a small effect on the apt (less
binding with thrombin) and strongly inhibits factor Xa;
Higher ratio of antifactor Xa to antifactor IIa activity
then unfractionated heparin
Kinetics:
Onset of action -- occurs 3-5 hours after subcutaneous administration
Duration -- persists in plasma ~ 12 hours
Half-life—2-4 times that of Heparin (1.5hrs)
No hepatic metabolism; slow,steady renal elimination
Adverse Reactions:
bleeding, erythema, thrombocytopenia, urticaria
Monitoring:
Platelets, occult blood
Drug Interactions:
Drugs affecting platelet function may potentiate risk of
hemorrhage (warfarin, aspirin, NSAIDs, dipyridamole, ticlopidine)
Dosing:
each LMWH has its own dosing values
Products:
Stroke Education
