Key result
Early ambulation and compression did not significantly increase the risk of developing a pulmonary embolism compared to bed rest and compression (RR 0.63; 95% CI 0.34-1.19) in patients with acute DVT.
Why the study?
Does early ambulation reduce or prevent the development of pulmonary embolism or progression of thrombus in patients with acute deep vein thrombosis compared to bed rest?
Systematic Review
Does early ambulation reduce or prevent the development of pulmonary embolism or progression of thrombus in patients with acute deep vein thrombosis compared to bed rest?
Relative Risk: 0.63 (95% CI 0.34–1.19)
p-value: p=not significant
Early ambulation in patients with acute DVT does not significantly increase the risk of developing a new PE or progressing DVT compared to bed rest, supporting the safety of early mobilization.
Supports early ambulation in acute DVT; confirms safety and strengthens guideline recommendations for mobilization.
PURPOSE: To systematically review the effects of early ambulation on development of pulmonary embolism (PE) and progression or development of a new thrombus in patients with acute deep vein thrombosis (DVT). METHODS: Medline, PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library databases were searched from inception to June 2008. Study quality was appraised using the Jadad and PEDro scales. Meta-analyses were reported as relative risks (RR) and 95% confidence intervals (CI). RESULTS: Four randomized trials were accepted. For development of a PE, the pooled relative risks for ambulation and compression versus bed rest and compression (RR = 0.63, 95% CI: 0.34-1.19) and for ambulation and compression versus bed rest alone (RR = 1.36, 95% CI: 0.57-3.29) were not significant. For progression of an existing thrombus or development of a new thrombus, the independent relative risks for ambulation and compression versus bed rest and compression (RR = 0.39, 95% CI: 0.13-1.14) and for ambulation and compression versus bed rest alone (RR = 0.56, 95% CI: 0.20-1.57) were also not significant. CONCLUSIONS: Given the clinical benefits of mobility, and because there was no significant difference between ambulation and bed rest for risk of developing a PE or development and progression of a new DVT in any of the studies, clinicians should be confident in prescribing ambulation in this population.
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Anderson et al. (2009) conducted a systematic review in Acute deep vein thrombosis (DVT). Early ambulation and compression vs. Bed rest and compression or bed rest alone was evaluated on Development of a pulmonary embolism (PE) (RR 0.63, 95% CI 0.34-1.19, p=not significant). Early ambulation and compression did not significantly increase the risk of developing a pulmonary embolism compared to bed rest and compression (RR 0.63; 95% CI 0.34-1.19) in patients with acute DVT.
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