Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin

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.