H. Partsch et W. Blattler, Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin, J VASC SURG, 32(5), 2000, pp. 861-868
Citations number
21
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: The purpose of this randomized controlled trial was to evaluate
the benefits of compression and walking exercises in comparison with bed re
st in the acute stage of proximal deep venous thrombosis (DVT).
Methods: Forty-five patients with proximal DVT that was proved with compres
sion ultrasound scan or phlebography were randomized into three groups. Gro
up A consisted of 15 patients who received inelastic compression bandages (
Unna boots on the lower leg, adhesive bandages on the thigh), and group B c
onsisted of 15 patients who received thigh-length compression stockings, cl
ass II. Group C consisted of 15 patients who underwent bed rest and no comp
ression. All patients received dalteparin, 200 IU/kg per body weight, subcu
taneously every 24 hours. The clinical characteristics of the three groups
were comparable. Primary end points were the reduction of pain assessed dai
ly with the Visual Analogue Scale and the Lowenberg test, the reduction of
leg circumference at the ankle and calf levels, and the improvement of clin
ical scores. The daily walking distance was measured with a pedometer. Safe
ty parameters were ventilation-perfusion scans and duplex ultrasound scans
performed on days 0 and 9.
Results: The daily walking distance was between 600 and 12,000 m in the com
pression groups and averaged 66 m in the bed rest group. The pain level sho
wed a statistically significant reduction starting after the second day in
the compression groups (A and B) and after 9 days in the bed rest group C (
P < .05). The same was true for the measurement of leg circumference. Impro
vement of the clinical scores was significantly better in the compression g
roups compared with, the bed rest group (P <.01). There was no significant
difference concerning the occurrence of new pulmonary emboli and regression
of thrombus diameter Progression of thrombi in the femoral vein was greate
r and occurred more frequently in the bed rest group than in the other two
groups (P = not significant).
Conclusion: Mobile patients with acute proximal DVT treated with low molecu
lar weight heparin should be encouraged to walk with compression bandages o
r medical compression stockings. The rate of resolution of pain and swellin
g is significantly faster when the patient ambulates with compression. The
risk of pulmonary embolism is not significantly increased by this approach.