Can neuromuscular electrostimulation fulfil an unmet need for mechanical thromboprophylaxis in acute stroke patients? A real-world retrospective analysis
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Aims and Method
This retrospective analysis examines real-world registry data to assess the incidence of symptomatic VTE in a non-randomised cohort where IPC was either contraindicated or not tolerated, leading to the use of Neuromuscular electrostimulation (NMES) to meet prophylactic needs. We consider the alternative VTE risk of no prophylactic intervention other than standard measures and utilise the data from the CLOTS 3 trial to evaluate the incidence of symptomatic VTE in a cohort that was randomly assigned to receive no IPC intervention, The outcomes from both cohorts are then compared to determine which group exhibits better clinical results.
Results
A comparison of symptomatic VTE incidence revealed a significantly lower rate in patients prescribed NMES as their first-line intervention of 1.5% compared to no IPC reported in CLOTS 3 (8.7%). The reduction in VTE risk between no IPC treatment and NMES as prescribed as a front-line sole intervention in the unmet need is statistically significant. (p<0.00001, Fisher’s exact test).
Health Economics
In terms of an economic analysis the average treatment with the NMES device in this pathway is 9 days and the cost of NMES is £243. In the unmet need scenario described above this results in an approximate 5% reduction in symptomatic VTE risk compared to no IPC intervention. The economic saving of this reduction in VTE risk compared to no IPC is modelled to be £303 per patient.
Conclusion
This retrospective analysis indicates that NMES offers an effective alternative for VTE mechanical prophylaxis in immobile acute stroke patients, a high-risk cohort, delivering significantly improved VTE outcomes compared to no IPC treatment. Further clinical insight from this registry suggests that the VTE outcomes achieved with the NMES device are comparable to those reported for IPC, further supporting its inclusion in the VTE prevention pathway.
