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Muhammad Shabbir
Abdurrahman M Alshahrani
Muath Al Ammar
Khaled Saqr Almuthairi
Mohammed Hwaifr
Osama Almuqaiteeb
Muhannad Mohammed Alashhab
Ambreen Liaqat


Venous thrombo-embolism (VTE) is one of the serious complications in stroke patients. Early diagnosis and proper treatment are warranted to mitigate morbidity and mortality. Epidemiological evidence available so far favours much lower risk of VTE among Asians. Pharmacological management against VTE is highly effective but it is expensive and increases the chances of bleeding. Can the antithrombotic treatment be recommended as a prophylaxis against VTE among Asian population or we have cheaper, effective, and safer options available? Nonpharmacological treatment to prevent the incidence of VTE include graduated compression stockings, intermittent pneumatic compressions and early mobilization. Putting these options into action without pharmacological treatment may prove sufficient and effective without risking the patients to suffer from bleeding complications, particularly in cases where the severity of illness and chances of VTE are low. In such cases, non-pharmacological prophylaxis may prove more cost effective. This will improve the quality of care in regions where most of the healthcare expenses are managed through out-of-pocket spending.

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Shabbir M, M Alshahrani A, Al Ammar M, Khaled Saqr Almuthairi, Mohammed Hwaifr, Osama Almuqaiteeb, Muhannad Mohammed Alashhab, Ambreen Liaqat. RISK EVALUATION OF THROMBO-EMBOLISM DURING STROKE IN ASIAN PATIENTS: NEED FOR PHARMACOLOGICAL THROMBOPROPHYLAXIS. J Postgrad Med Inst [Internet]. 2023 Aug. 27 [cited 2024 May 30];37(3):161-5. Available from: https://jpmi.org.pk/index.php/jpmi/article/view/3232
Review Article


Shabbir M, Ahmad A. Campaign—Once Again Streptokinase Trials (COAST) in Acute Ischemic Stroke. J of Stroke and Cerebrovasc Dis. 2018;27(3):819-20. DOI:10.1016/j.jstrokecerebrovasdis.2017.11.021.

Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation. 2020;141(9):e139-596. DOI:10.1161/ CIR.0000000000000950.

Atlanta G. Underlying Cause of Death. Centers for Disease Control and Prevention. 2020;12:1999-18.

Liu LP, Zheng HG, Wang DZ, Wang YL, Hussain M, Sun HX et al. Risk Assessment of Deep-Vein Thrombosis After Acute Stroke: a Prospective Study Using Clinical Factors. CNS Neurosci Ther. 2014;20(5):403-10. DOI:10.1111/ cns.12227

Kelly J, Rudd A, Lewis RR, Coshall C, Moody A, Hunt BJ. Venous thromboembolism after acute ischemic stroke: a prospective study using magnetic resonance direct thrombus imaging. Stroke. 2004;35(10):2320-5. DOI:10.1161/01. STR.0000140741.13279.4f.

Kamran SI, Downey D, Ruff RL. Pneumatic sequential compression reduces the risk of deep vein thrombosis in stroke patients. Neurology. 1998;50(6):1683- 8. DOI:10.1212/wnl.50.6.1683.

Davenport RJ, Dennis MS, Wellwood I, Warlow CP. Complications after acute stroke. Stroke. 1996;27(3):415-20. DOI:10.1161/01.str.27.3.415.

The International Stroke Trial (IST): a randomised trial of aspirin, subcutaneous heparin, both, or neither among 19435 patients with acute ischaemic stroke. International Stroke Trial Collaborative Group. Lancet. 1997;349(9065):1569-81. DOI:10.1016/S0140-6736(97)04011- 7.

Paciaroni M, Agnelli G, Venti M, Alberti A, Acciarresi M, Caso V. Efficacy and safety of anticoagulants in the prevention of venous thromboembolism in patients with acute cerebral hemorrhage: a meta-analysis of controlled studies. J Thromb Haemost. 2011;9(5):893-8. DOI:10.1111/ j.1538-7836.2011.04241.x.

10. Bath PM, Iddenden R, Bath FJ. Low-molecular-weight heparins and heparinoids in acute ischemic stroke : a meta-analysis of randomized controlled trials. Stroke. 2000;31(7):1770-8. DOI:10.1161/01.str.31.7.1770

11. Goldhaber SZ. Venous thromboembolism: epidemiology and magnitude of the problem. Best Pract Res Clin Haematol. 2012;25(3):235-42. DOI:10.1016/j. beha.2012.06.007.

12. Bembenek J, Karlinski M, Kobayashi A, Czlonkowska A. Early stroke-related deep venous thrombosis: risk factors and influence on outcome. J Thromb Thrombolysis. 2011;32(1):96-102. DOI:10.1007/s11239-010-0548-3.

13. Kappelle LJ. Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Options Neurol. 2011 Dec;13(6):629-35. DOI:10.1007/s11940-011-0147-4.

14. Angchaisuksiri P, Goto S, Farjat AE, Fryk H, Bang SM, Chiang CE et al. Venous thromboembolism in Asia and worldwide: Emerging insights from GARFIELD-VTE. Thromb Res. 2021;201:63-72. DOI:10.1016/j. thromres.2021.02.024.

15. Lee LH, Gallus A, Jindal R, Wang C, Wu CC. Incidence of Venous Thromboembolism in Asian Populations: A Systematic Review. Thromb Haemost. 2017;117(12):2243-60. DOI:10.1160/ TH17-02-0134.

16. Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med. 2013;126(9):832.e13-21. DOI:10.1016/j.amjmed.2013.02.024.

17. Hong J, Lee JH, Yhim HY, Choi WI, Bang SM, Lee H, Oh D. Incidence of venous thromboembolism in Korea from 2009 to 2013. PLoS One. 2018;13(1):e0191897. DOI:10.1371/ journal.pone.0191897.

18. Ha SH, Kim YJ, Heo SH, Chang DI, Kim BJ. Prediction of deep vein thrombosis by ultrasonography and D-dimer in Asian patients with ischemic stroke. BMC Neurol. 2020;20(1):257. DOI:10.1186/s12883-020-01842-w.

19. Tan SSS, Venketasubramanian N, Ong PL, Lim TCC. Early deep vein thrombosis: incidence in Asian stroke patients. Ann Acad Med Singapore. 2007;36(10):815-20. DOI:10.1186/ s12883-020-01842-w

20. Liew NC, Alemany GV, Angchaisuksiri P, Bang SM, Choi G, DE Silva DA, et al. Asian venous thromboembolism guidelines: updated recommendations for the prevention of venous thromboembolism. Int Angiol. 2017;36(1):1-20. DOI:10.23736/ S0392-9590.16.03765-2.

21. Zakai NA, McClure LA. Racial differences in venous thromboembolism. J Thromb Haemost. 2011;9(10):1877- 82. DOI:10.1111/j.1538- 7836.2011.04443.x.

22. Wendelboe AM, McCumber M, Hylek EM, Buller H, Weitz JI, Raskob G; ISTH Steering Committee for World Thrombosis Day. Global public awareness of venous thromboembolism. J Thromb Haemost. 2015;13(8):1365-71. DOI:10.1111/jth.13031.

23. Lee LH. Clinical update on deep vein thrombosis in Singapore. Ann Acad Med Singap. 2002;31(2):248-52.

24. Klatsky AL, Baer D. What protects Asians from venous thromboembolism? Am J Med. 2004;116(7):493-5. DOI:10.1016/j.amjmed.2004.01.005.

25. Stein PD, Matta F. Epidemiology and incidence: the scope of the problem and risk factors for development of venous thromboembolism. Clin Chest Med. 2010;31(4):611-28. DOI:10.1016/j. ccm.2010.07.001.

26. Tran NH, Klatsky AL. Lower risk of venous thromboembolism in multiple Asian ethnic groups. Preventive Medicine Reports. 2019;13(44):268-9. DOI:10.1016/j.pmedr.2019.01.006.

27. Wang KL, Yap ES, Goto S, Zhang S, Siu CW, Chiang CE. The diagnosis and treatment of venous thromboembolism in Asian patients. Thrombosis Journal. 2018;16(1):76. DOI:10.1186/s12959- 017-0155-z.

28. Sherman DG, Albers GW, Bladin C, Fieschi C, Gabbai AA, Kase CS, et al. The efficacy and safety of enoxaparin versus unfractionated heparin for the prevention of venous thromboembolism after acute ischaemic stroke (PREVAIL Study): an open-label randomised comparison. Lancet. 2007;369(9570):1347-55. DOI:10.1016/S0140-6736(07)60633- 3.

29. Bath PM, Iddenden R, Bath FJ. Low-molecular-weight heparins and heparinoids in acute ischemic stroke : a meta-analysis of randomized controlled trials. Stroke. 2000;31(7):1770-8. DOI:10.1161/01.str.31.7.1770.

30. Ho KM, Tan JA. Stratified meta-analysis of intermittent pneumatic compression of the lower limbs to prevent venous thromboembolism in hospitalized patients. Circulation. 2013;128(9):1003- 20. DOI:10.1161/CIRCULATIONAHA.113.002690. .

31. Sharfman ZT, Campbell JC, Mirocha JM, Spitzer AI. Balancing Thromboprophylaxis and Bleeding in Total Joint Arthroplasty: Impact of Eliminating Enoxaparin and Predonation and Implementing Pneumatic Compression and Tranexamic Acid. J Arthroplasty. 2016;31(6):1307-12. DOI:10.1016/j. arth.2015.11.046.

32. Torrejon Torres R, Saunders R, Ho KM. A comparative cost-effectiveness analysis of mechanical and pharmacological VTE prophylaxis after lower limb arthroplasty in Australia. J Orthop Surg Res. 2019;14(1):93. DOI:10.1186/s13018-1124-y.

World Health Organization. ( 2020) . World health statistics 2020: monitoring health for the SDGs, sustainable development goals. World Health Organization. Available from URL: https://apps. who.int/iris/handle/10665/332070.

Sirag A, Mohamed Nor N. Out-of-Pocket Health Expenditure and Poverty: Evidence from a Dynamic Panel Threshold Analysis. Healthcare. 2021;9(5):536. DOI:10.3390/healthcare9050536.