15 May The geko™ device – addressing post-stroke unmet need VTE prophylaxis
During this year’s National Thrombosis Week (1st-7th May 2023), Dr. Indira Natarajan, Stroke Physician at Royal Stoke University Hospital, delivered a presentation at Thrombosis UK’s annual virtual conference discussing the unmet need of VTE prophylaxis in acute stroke patients. The presentation highlighted how, through the adoption of the geko™ device, his clinical team at Royal Stoke were able to achieve 100 percent VTE prophylaxis across the stroke ward. Dr. Natarajan began his talk by detailing the current treatments available for VTE prevention and their limitations.
Addressing the Unmet Need
In his talk, Dr. Natarajan explained how graduated compression stockings (GCS) and intermittent pneumatic compression (IPC) – a boot-like cuff that compresses to promote blood flow, can be ineffective forms of VTE prevention for some patients. According to clinical trials CLOTS1 and CLOTS 2, GCS was reported ineffective post-stroke, while IPC recorded a 60-70 percent compliance rate. Prescribing drugs like low molecular weight heparin to prevent VTE equally poses its own limitations and risks, with an unpredictable risk of bleeding and a need to monitor patients constantly.
At the NHS Royal Stoke Hospital stroke unit, IPC is the first line of treatment for all acute stroke patients in the first 30 days of admission and after 14 days, coagulation is considered in higher-risk patients. As a result, Dr. Natarajan and his team were keen to embrace new treatments of care to deliver greater outcomes with the geko™ device.
The geko™ device is a small non-invasive wearable device that is worn on the leg, stimulating the common peroneal nerve to increase blood flow. During a real-world audit of clinical practice conducted by Royal Stoke University Hospital, the geko™ device was evaluated as an alternative intervention, when IPC cannot be prescribed. Results showed the geko™ device was well tolerated with a 90.8% adherence rate, compared to 78 percent for IPC. The audit also revealed 29.5% of patients were unable to be prescribed IPC due to contraindication or intolerance. It was to this patient group the geko™ device was prescribed. Subsequent adoption of the geko™ device has led to a 46% reduction in VTE in immobile acute stroke patients, within the unit.
A Brighter Future
With the geko™ device in service, its use has transformed clinical practice in the acute stroke unit at the NHS Royal Stoke Hospital, where it is now in routine use. Its impact has led to the theory that the geko™ device could be more effective than IPC, rather than geko™ device for unmet need alone. A head-to-head multi-center randomised controlled trial (RCT) is now underway in the UK, funded by an NIHR i4i grant. The study is being run jointly by stroke survivors, clinical researchers, stroke physicians, academic staff at Keele University and Sky Medical Technology, with the primary objective to measure venous thromboembolism outcomes within 30 days of randomisation, across 1,200 patients in 10 stroke services. Secondary objectives will compare product safety, patient tolerance, survival, functional outcomes, quality of life in addition to health, economic and environmental impact.
Dr. Indira Natarajan’s presentation was streamed to an audience of healthcare professionals from around the world, seeking the latest developments in VTE preventative care. For more information on thrombosis care, visit Thrombosis UK.