Background Venous Thromboembolism (VTE) prophylaxis using Intermittent Pneumatic Compression (IPC) is not possible in all stroke patients. We introduced a new VTE pathway which includes Neuromuscular Electrical Stimulation of the peroneal nerve using the gekoTM device (Firstkind Ltd UK) as an alternative prevention strategy for this patient group. In addition, compliance with VTE prophylaxis was reviewed 4-hourly as part of comfort rounds. 
Methods This is a prospective audit of the new pathway. All stroke patients admitted to the Acute Stroke Unit at Royal Stoke University Hospital between 1 Nov 2016 and 3 Mar 2018 were included. In line with UK guidelines patients unable to mobilize independently were prescribed IPC in addition to standard measures, e.g. hydration, mobilization, and aspirin where indicated, unless patients were palliative, fully anticoagulated, or refused the intervention. Patients who could not use IPC (intolerance, falls risk, out of stock) were switched to the gekoTM device. 
Results In total 999 stroke patients were included. Of these 187 (18.7%) required no prophylaxis, 125 (12.5%) were fully anti-coagulated, and 687 (68.7%) required mechanical VTE prophylaxis (MP). Of these 463 (67.3%) received IPC and 122 (17.7%) the gekoTM device as their only intervention. A further 81 (11.8%) patients became intolerant to IPC and were prescribed the gekoTM as a secondary intervention and 21 (3.1%) refused treatment. The gekoTM was used in 203 (29.5% of MP). 
At 90 days there were 15 (1.5%) VTE (symptomatic DVT or PE). Of these 13 occurred in the MP group: 11 (6 DVT, 5 PE) in the ‘IPC only cohort’, 1 in ‘IPC with secondary gekoTM’, 0 in the ‘gekoTM only’ cohort, and 1 (PE) in ‘refused prophylaxis’. A further 2 VTE where recorded: 1 (DVT) in ‘prophylaxis not required’ and 1 (DVT) in ‘on anticoagulant’. The gekoTM was used for a mean of 9 days/patient and was well tolerated without serious adverse events. 
Conclusion The new strategy of increased surveillance, and use of the gekoTM device where indicated, for patients who cannot use IPC was associated with a low overall incidence of symptomatic VTE (1.5%). The incidence in high risk immobile patients requiring MP was 1.9% (13/687), which is lower than the 6.6% in a comparable patient population in the CLOTS-3 study.

The use of the GEKO device and the activation of the foot and calf pumps for prevention of venous thromboembolism in patients with acute stroke.