The geko™ device for VTE prophylaxis - serving an unmet need in high-risk acute stroke patients

Current UK practice for DVT prophylaxis in acute stroke patients is based upon data from the CLOTS 3 study and usually comprises of Intermittent Pneumatic Compression (IPC) or a prophylactic-dose of Low Molecular Weight Heparin (LMWH) when the bleed risk is reduced1. However, regardless of these interventions, a small group of patients remain contraindicated to these therapies leaving them exposed to developing a DVT or PE.

 

Firstkind Ltd, a UK based medical devices company, is working with an NHS Trust to introduce the innovative geko™ device into the acute stroke pathway, when patients are unsuitable for drug prophylaxis and/or contraindicated to IPC.

 

The geko™ is a battery powered, disposable, neuromuscular electrostimulation device designed to increase blood flow in the deep veins of the leg2. The geko™ gently stimulates the common peroneal nerve activating the calf and foot muscle pumps increasing venous, arterial and microcirculatory blood flow. The blood flow increase is equal to 60%3 of walking without a patient having to move or exert energy.  

 

Patient compliance and the geko™ anti-stasis capability is being assessed through a prospective audit of clinical practice, covering patients who have been admitted for either ischemic or haemorrhagic stroke4. Patients unsuitable for VTE drug prophylaxis or contraindicated to IPC are being given the geko™ device.  

Interim analysis highlights that the majority of high risk immobile acute stroke patients who could not tolerate IPC are able to tolerate the geko™. These patients would have not been treated as effectively otherwise, with the potential that geko™ will reduce the risk of morbidity and mortality in stroke patients. For more information on the geko™ device, click here: http://www.gekodevices.com/en-uk/

  1. NICE guidelines (CG92). Published date January 2010, update June 2015.
  2. Nicolaides, M Griffin, Measurement of blood flow in the deep veins of the lower limb using the geko™ neuromuscular electro-stimulation device. Journal of International Angiology August 2016-04.
  3. Tucker A, Maass A, Bain D, Chen LH, Azzam M, Dawson H, et al. Augmentation of venous, arterial and microvascular blood supply in the leg by isometric neuromuscular stimulation via the peroneal nerve. The International journal of angiology: official publication of the International College of Angiology, Inc. 2010 Spring; 19(1): e31-7.
  4. Stoke, prospective data on file, prospective April 2017, Firstkind.

CLOT Conference 2018

Following on from our recent conference we have booked the same venue, Crowne Plaza Central Manchester for next year on the 12th October 2018. We will look at feedback and any suggestions or comments and have more detail next year. The CLOT Committee

CLOT Conference 2017

The closing date for this years conference is this Friday the 15th September so don't delay and book today 

My first ISTH Experience

This is written by Sarah Keen VTE prevention specialist nurse from Oxford who was given a CLOT travel award to attend the conference. We had planned to publish in Thrombus magazine but that is not currently being produced so were keen for her to share her experience.

If I had to sum up my ISTH experience in one word it would be- INSPIRING!

I would like to thank the CLOT committee for giving me the opportunity to attend the ISTH congress in Berlin.

I started as a VTE prevention specialist nurse at Oxford University Hospitals NHS Foundation Trust a year ago.  

In my nursing carer I have attended regular conferences around the UK, however this is the first opportunity I have had to network with peers from other organisations and health care settings from around the world.

At the ISTH congress I attended outstanding talks and sessions on thrombosis and VTE prevention which gave me the opportunity to learn about the most up to date research and to identify new practices being implemented and the success of these at an international level. 

The experience has positively impacted upon my current practice and has helped to identify gaps in my knowledge and the areas of work for me to focus on. Examples of research areas in which I was particularly interested was patient education on cancer associated thrombosis and the psychological effects of thrombosis. I hope to utilise and implement key learning points brought back from the nursing forum relating to these topics.  I have now started to research ideas and hope to implement these throughout the Oxford University Hospitals Foundation Trust in the coming years.

Attending ISTH was an excellent opportunity for networking and for facilitating the sharing of practices internationally. I now have contacts for other healthcare professionals around the world and the conference has enabled me to share my experiences and practice with other professionals in the field of thrombosis and VTE prevention. I feel that the progress which we have already made in our Trust over the recent years could help other organisations. Sharing practices with other specialist nurses was a great pleasure and hearing their feedback and enthusiasm with regards to the work we have done in Oxford to improve patient safety and quality of care made every hour I spent extra at work worth it. I would like to thank the CLOT committee for their role in fostering my continuing enthusiasm and passion for this fascinating area of medicine.

Trial published looking at Extended VTE treatment with Rivaroxaban

A RCT was published in the New England Journal of Medicine in March 2017 looking at equipoise patients who had completed six to twelve months of treatment for VTE. A total of 3396 patients were randomised to receive either aspirin 100mg daily or Rivaroxaban (10mg or 20mg) once daily. The primary efficacy outcome was symptomatic recurrent fatal or nonfatal venous thromboembolism, and the principal safety outcome was major bleeding.

The results seen were the primary efficacy outcome occurred in 17 of 1107 patients (1.5%) receiving 20 mg of rivaroxaban and in 13 of 1127 patients (1.2%) receiving 10 mg of rivaroxaban, as compared with 50 of 1131 patients (4.4%) receiving aspirin (hazard ratio for 20 mg of rivaroxaban vs. aspirin, 0.34; 95% confidence interval [CI], 0.20 to 0.59; hazard ratio for 10 mg of rivaroxaban vs. aspirin, 0.26; 95% CI, 0.14 to 0.47; P<0.001 for both comparisons). Rates of major bleeding were 0.5% in the group receiving 20 mg of rivaroxaban, 0.4% in the group receiving 10 mg of rivaroxaban, and 0.3% in the aspirin group; the rates of clinically relevant nonmajor bleeding were 2.7%, 2.0%, and 1.8%, respectively. The incidence of adverse events was similar in all three groups.

The conclusions Among patients with venous thromboembolism in equipoise for continued anticoagulation, the risk of a recurrent event was significantly lower with rivaroxaban at either a treatment dose (20 mg) or a prophylactic dose (10 mg) than with aspirin, without a significant increase in bleeding rates.

The abstract is available at http://www.nejm.org/doi/full/10.1056/NEJMoa1700518