H. Partsch et al., THE EFFECT OF MOBILIZATION OF PATIENTS DURING TREATMENT OF THROMBOEMBOLIC DISORDERS WITH LOW-MOLECULAR-WEIGHT HEPARIN, International angiology, 16(3), 1997, pp. 189-192
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
.