Key result
Immediate leg compression and walking in patients with acute DVT does not increase the risk of symptomatic PE compared to bed-rest, and reduces pain, swelling, and postthrombotic syndrome.
Why the study?
Does immediate leg compression and walking improve symptoms and prevent postthrombotic syndrome without increasing symptomatic PE risk in mobile outpatients with acute DVT compared to bed-rest?
Does immediate leg compression and walking improve symptoms and prevent postthrombotic syndrome without increasing symptomatic PE risk in mobile outpatients with acute DVT compared to bed-rest?
Immediate leg compression and walking is a safe and effective alternative to bed-rest for mobile patients with acute DVT, reducing symptoms and postthrombotic syndrome without increasing PE risk.
Mobilization in acute DVT under anticoagulation does not raise symptomatic PE risk; leaves open need for RCTs before practice change.
Up until today mobile outpatients are put into bed as soon as the diagnosis of deep vein thrombosis (DVT) is made. Fear of pulmonary embolism (PE) is the main rationale for bed-rest; additional arguments are pain and swelling which are expected to resolve faster during leg elevation. Based on previous work it is demonstrated that keeping mobile patients with acute DVT walking under exact anticoagulation does not increase the risk for symptomatic PE in comparison with bed-rest and that there is an immediate reduction of pain and swelling when good compression is applied and the patient is encouraged to walk. Immediate compression and walking seems also to reduce the incidence of a postthrombotic syndrome. One presumed mechanism of action of this adjunct treatment modality is the increase of shear stress in the microcirculation of the vein wall releasing anti-inflammatory and anti-coagulatory mediators.
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H Partsch (2014) conducted a review in Deep vein thrombosis (DVT). Leg compression and walking vs. Bed-rest was evaluated on Symptomatic pulmonary embolism (PE), pain, swelling, and postthrombotic syndrome. Immediate leg compression and walking in patients with acute DVT does not increase the risk of symptomatic PE compared to bed-rest, and reduces pain, swelling, and postthrombotic syndrome.
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