THE EFFECT OF MOBILIZATION OF PATIENTS DURING TREATMENT OF THROMBOEMBOLIC DISORDERS WITH LOW-MOLECULAR-WEIGHT HEPARIN

Objective. To elucidate the risk of pulmonary embolism (PE) in patient s with deep Vein thrombosis (DVT) who are kept walking with compressio n bandages. Experimental design. Perfusion/ventilation scanning of the lung was performed at admission and after 10 days of treatment. Setti ng. General community hospital. Patients. A total of 631 consecutive p atients were studied (upper limit of the thrombi: iliofemoral vein, n= 212; femoral or popliteal vein, n=302; lower leg, n=117). The patients received different dose regimens of low-molecular-weight heparin (dal teparin) subcutaneously. Results. The study revealed that the prevalen ce of PE at baseline was between 45.1% and 51% (95% CI 38.2-55.2 and 4 5.2-56.8% respectively) in patients with proximal DVT, and 31.9% (95% CI 23.6-41.2%) in those with DVT restricted to the lower leg. The majo rity of these cases of PE were completely asymptomatic. The incidence of a new PE, revealed by a second lung scan on day 10 after admission, was 7.0% (95% CI 3.9-11.4%) in patients with iliofemoral DVT, 5.5% (9 5% CI 3.2-8.7%) in those with femoropopliteal DVT and 2.7% (95% CI 0.6 -7.6%) in those with lower-leg DVT. These incidence rates for new PEs were significantly lower than the rates previously reported (p<0.01). The fatality rate was also lower compared with the literature: one pat ient suffered a fatal PE (0.2%; 95% CI 0-0.9%), four patients died fro m malignant tumours, and one from pneumonia. The frequency of malignan t tumours was greater in this study than in the literature (23% in pat ients with iliofemoral DVT, 14% in those with femoropopliteal DVT and 9% in those with DVT of the lower leg). Conclusion. Mobile patients wi th DVT do not need bedrest. Low-molecular-weight heparin sc., compress ion bandages and walking exercises make home-treatment of DVT feasible .