The effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism during stroke rehabilitation: a historical cohort study.
OBJECTIVE
To determine the effectiveness of anticoagulant and antiplatelet agents in preventing venous thromboembolism (VTE) during stroke rehabilitation.


METHODS
Historical cohort study.


METHODS
Acute inpatient rehabilitation hospital.


METHODS
Consecutive patients (N=1506) with ischemic and hemorrhagic stroke admitted for rehabilitation.


METHODS
Documented use of anticoagulants (warfarin or anticoagulant doses of heparin), heparin in prophylactic doses, and antiplatelet agents.


METHODS
Occurrence of deep vein thrombosis detected by ultrasound or venography or pulmonary embolism detected by ventilation perfusion scan, spiral computed tomography, or pulmonary angiography.


RESULTS
Fifty-eight VTE events occurred (3.9% incidence or 1.36 events per 1000 patient days), with higher risk in patients with severe stroke. Only therapeutic anticoagulation had a statistically significant protective effect for VTE risk in univariate analysis (odds ratio [OR]=.44; 95% confidence interval [CI],.20-.98). After adjusting for multiple medication use and other factors, including age, stroke onset to admission interval, length of rehabilitation stay, cause of stroke, and admission National Institutes of Health Stroke Scale score, therapeutic anticoagulation gave strong protection against VTE (OR=.37; 95% CI,.15-.88), followed by heparin (OR=.48; 95% CI,.23-.98) but not by antiplatelet agents (OR=.79; 95% CI,.40-1.57). No medications were associated with significant bleeding complications.


CONCLUSIONS
Use of therapeutic anticoagulants or prophylactic heparin prevented VTE in stroke patients during inpatient rehabilitation.
Harvey
Richard L
RL
The Rehabilitation Institute of Chicago, 345 E. Superior Street, Chicago, IL 60611, USA. r-harvey@northwestern.edu
Lovell
Linda L
LL
Belanger
Nicole
N
Roth
Elliot J
EJ
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011655:Pulmonary Embolism / Q000209:etiology / Q000517:prevention & control*; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D020246:Venous Thrombosis / Q000209:etiology / Q000517:prevention & control*
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D006493:Heparin