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Innovation addressing VTE unmet need in stroke patients



Bernard Ross, CEO of Sky Medical Technology, gives SR Times his views on VTE and how innovation is helping to address an unmet need in stroke patients.

Cerebrovascular diseases – conditions related to blood flow in the brain – are one of the leading causes of death in the UK, with stroke accounting for roughly 75 percent of these cases. There are approximately 126,000 hospital admissions due to stroke per year in England alone, and more than one million people living with stroke in the UK. 

Recovery from acute stroke can take months, or even years, and requires careful management of potentially severe complications. This includes venous thromboembolism (VTE – the medical term for blood clots), cerebral oedema (brain swelling), seizures, and cardiac complications, as well as long-term issues like mobility problems (falls, Ataxia, spasticity and contractures), sensory problems, pain, and fatigue, among others. One in seven people with acute stroke die in hospital, with a large portion of these deaths being due to blood clots. 

A Silent Killer

VTE is a blood clot that starts in a vein and has two classifications: Deep Vein Thrombosis (DVT) – clots that typically develop in the lower leg, thigh, or pelvis – and Pulmonary Embolism (PE) – a blood clot in the deep veins of the leg that breaks off and travels to the lung.

VTE is regarded as a silent killer in that it strikes rapidly, sometimes without signs and symptoms, and it can have life-threatening implications. It is the leading cause of hospital-acquired death and disability; specifically PE, which is associated with 13–25 percent of deaths in the early period following stroke. What’s significant is that around 70 percent of blood clot-related deaths are preventable given the proper treatment. 

Preventing VTE in Acute Stroke

Acute stroke patients are at a high risk of developing VTE due to the nature of stroke recovery and rehabilitation. The longer patients are required to recover in hospital, the less mobile they are likely to be over time – slowing blood circulation and increasing the risk of clotting. 

Standard of care VTE prevention, recommended by NICE Guidance, is Intermittent Pneumatic Compression (IPC) – a boot-like cuff that compresses the leg to promote blood flow back to the heart. Alternatively, patients may be prescribed drug prophylaxis such as low molecular weight heparin, however, the risk of bleeding has been deemed too high in stroke patients to be prescribed drug prophylaxis. IPC is typically prescribed as first-line treatment for all acute stroke patients in the initial 30 days following stroke. 

Identifying an Unmet Need

According to the CLOTS3 study, IPC reduces the 30-day VTE risk by 3.6 percent compared to no VTE prophylaxis. However, IPC can be unsuitable for approximately 31 percent of patients for various reasons, including dermatitis, leg ulcers, and severe oedema, among others. This means that around one-third of stroke patients can be left without any VTE preventative care when they are recovering in hospital. 

Fortunately, innovation in medical technology (MedTech) is helping healthcare systems address this unmet need. For instance, wearable neuromuscular electrostimulation devices, like the geko™ device, offer a non-invasive alternative to VTE prevention for patients who cannot be prescribed standard of care. The geko™ device gently stimulates the common peroneal nerve activating the calf and foot muscle pumps, resulting in increased blood flow in the deep veins of the calf – at a rate equal to 60 percent of walking without a patient having to move. The blood flow volume and velocity is clinically proven to prevent blood pooling and clotting. 

Embracing Innovation For Improved Patient Outcomes

The Royal Stoke University Hospital is reaping the benefits of innovation adoption across its stroke unit having adopted the geko™ device to address its unmet need for VTE prophylaxis. Following an audit of clinical practice, they have incorporated geko™ into standard of care, meaning staff can now offer 100 percent VTE prophylaxis to immobile acute stroke patients, who previously would have had no other intervention available to them.

The adoption of MedTech devices, such as geko™ device, not only improves patient outcomes but reduces healthcare systems costs. NICE guidance (MTG19) shows a cost-saving of £197* per patient when the geko™ device is used for a period of six days, when compared to no VTE prophylaxis and that under these circumstances use of the device will be cost-saving until day 14.

*The cost saving specific to acute stroke is £337 per patient, according to recent health economic modelling.  

Building a Brighter Future

MedTech is uniquely placed to drive positive change in healthcare, benefiting patients, healthcare professionals and global healthcare systems as a whole. Innovations that can demonstrate better patient outcomes, as well as cost-saving benefits, have the power to transform stroke recovery and rehabilitation – and healthcare delivery.