Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation

Background: Traditionally, patients with acute deep vein thrombosis (DVT) a re treated with strict bed rest for several days to avoid clots from breaki ng off and causing pulmonary emboli, The purpose of this study is to give a precise estimate of short term complications like pulmonary embolism, blee ding, heparin-induced thrombocytopenia (HIT) and death in a cohort of conse cutive patients who were admitted because of acute symptomatic DVT all trea ted by compression and walking exercises instead of conventional bed-rest a nd nearly, all by, low-molecular-weight heparin. Patients and methods: In 1289 consecutive patients the following five endpo ints were registeredfor the period of hospital-stay: 1. Frequency of pulmon ary embolism (PE) at admission (V/Q lung scan), 2. Frequency of new PE's af ter 10 days (second lung scan), 3. Fatal events (autopsy), 4. Frequency of malignant disease, 5. Bleeding complications and HIT Results: 1. 190/356 (53.4% of iliofemoral, 355/675 (52.6%) of femoral and 8 4/239 (35.1%) of lower leg vein thrombosis showed PE(difference iliofemoral and femoral versus lower leg DVT p < 0.001). Two thirds of these PE were a symptomatic. 2. New PE after 10 days in comparison to the baseline scan occ urred in 7.4%, 6.4% and 3.4% respectively. 3. Fatal events, all investigate d by autopsy, were caused by PE in 3 patients aged over 76 years (0.23%), b y malignant diseases in 12 (0.9%) and due to other causes in 2 (0.15%). 4. 232 patients (18%) had associated malignant diseases, from which 33% were d etected by our screening. 5. Non-fatal bleeding complications were seen in 3.3%, including 5 patients (0.4%) with major bleeding. Three patients (0,2% ) suffered from HIT II. Conclusion: The low incidence of recurrent and fatal pulmonary emboli in th is series affirms the value of early, ambulation with heavy leg compression in patients with symptomatic acute leg deep venous thrombosis. In addition , the presence of pulmonary emboli in one-third of those with calf vein thr ombi emphasizes the importance of fully diagnosing and treating calf clots.