Prophylaxis of Venous Thrombosis in Neurocritical Care Patients

1) We recommend initiating venous thromboembolism (VTE) pharmacoprophylaxis as soon as is feasible in all patients with acute ischemic stroke.

2) In patients with acute ischemic stroke and restricted mobility, we recommend prophylactic-dose Low-molecular-weight heparin (LMWH) over prophylactic-dose unfractionated heparin (UFH) in combination with intermittent pneumatic compression (IPC).

3) Due to insufficient evidence, the panel could not issue a recommendation regarding the use of compression stockings (CS) for VTE prophylaxis although their use does not appear to be harmful.

4) In stroke patients undergoing hemicraniotomy or endovascular procedures, we suggest the use of UFH, LMWH, and/or IPC for VTE prophylaxis in the immediate postsurgical or endovascular epoch except when patients have received rTPA, in which case prophylaxis should be delayed 24 h.