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CLOTS 3

The CLOTS 3 study investigates the efficacy of Intermittent Pneumatic Compression (IPC) in reducing Deep Vein Thrombosis (DVT) after acute stroke. Enrolled were 2876 patients across 105 UK centers from December 2008 to September 2012. The study found IPC to be feasible and safe, significantly decreasing proximal DVT rates with a cumulative hazard ratio of 0.86. Further, it indicates potential improvements in overall survival rates. These findings suggest that IPC could be an effective prophylaxis for venous thromboembolism in stroke patients.

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CLOTS 3

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  1. CLOTS 3 Multicentre randomised trial to evaluate Intermittent Pneumatic Compression in patients with acute stroke Martin Dennis on behalf of The CLOTS trials collaboration

  2. Venous thromboembolism after stroke PE DVT 20% 5% symptomatic PE 10% on screening MRI Diagnosed in <3%

  3. Background • Graduated compression stockings • reduce the risk of DVT in surgical patients • do not reduce risk of DVT in stroke (CLOTS 1) • Intermittent Pneumatic Compression • reduce the risks of DVT in surgical patients • not adequately tested in stroke or medical patients

  4. Research Question Does IPC reduce the frequency of DVT after stroke?

  5. Immobile Stroke patient Day 0-3 of admission Routine care & No IPC Duplex of both legs at 7-10 days Duplex of both legs at 25-30 days 6 months follow up CLOTS 3 Routine care & IPC

  6. CLOTS 3 - Conduct • 2876 enrolled by 105 centres in UK • Dec 2008 to Sept 2012 • Excellent balance for all baseline variables & post enrolment anti-thrombotics

  7. CLOTS 3 – EfficacyPrimary outcome % P=0.001 Proximal DVT

  8. No IPC IPC Cumulative Hazard Hazard Ratio = 0.86 (95%CI 0.73 - 0.99) p=0.042 Survival time (days) Probability of Death within 6 months

  9. Conclusions • IPC is feasible and safe • IPC is an effective form of VTE prophylaxis NNT = 28 for proximal DVT • It probably improves overall survival NNT~ 43 for death in 30 days • Effective in ischaemic & haemorrhagic stroke

  10. More details available Expedited publication today at http://www.thelancet.com/

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