Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis: a prospective, randomized, open, multicentre trial

Jünger, Michael; Diehm, Curt; Störiko, Helge; Hach-Wunderle, V.; Heidrich, H; Karasch, T; Ochs, Hermann R.; Ranft, J; Sannwald, G.; Strölin, Anke; Janssen, Detlev

doi:10.1185/030079906x89838

Cited by 43 publications

(48 citation statements)

References 9 publications

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“…Four studies were finally accepted for inclusion in this review (see Table 1). 6,8,9,19 We obtained additional data from one 6 of two reports. 6,20 Quality scores for the Jadad scale for these four studies ranged from 1 to 3 of a possible 5, with a mean score of 2.…”

Section: Resultsmentioning

confidence: 99%

“…9,19 Subjects in all four studies had proximal DVT and were treated as in-patients, and all received anticoagulation therapy upon diagnosis of the DVT. Two of the four studies included only patients with symptomatic DVTs 6,9 ; the others did not indicate whether the subjects had symptomatic or asymptomatic DVTs.…”

Section: Resultsmentioning

confidence: 99%

“…Two of the four studies included only patients with symptomatic DVTs 6,9 ; the others did not indicate whether the subjects had symptomatic or asymptomatic DVTs. 8,19 Ambulation was started immediately following randomization in three of the four studies 6,8,19 and on the day following randomization in the fourth. 9 The mean age for the groups in the studies ranged from 52 to 66 years (see Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Ambulation after Deep Vein Thrombosis: A Systematic Review

Anderson¹,

Overend²,

Godwin³

et al. 2009

Physiotherapy Canada

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Purpose: To systematically review the effects of early ambulation on development of pulmonary embolism (PE) and progression or development of a new thrombus in patients with acute deep vein thrombosis (DVT). Methods: Medline, PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library databases were searched from inception to June 2008. Study quality was appraised using the Jadad and PEDro scales. Meta-analyses were reported as relative risks (RR) and 95% confidence intervals (CI). Results: Four randomized trials were accepted. For development of a PE, the pooled relative risks for ambulation and compression versus bed rest and compression (RR ¼ 0.63, 95% CI: 0.34-1.19) and for ambulation and compression versus bed rest alone (RR ¼ 1.36, 95% CI: 0.57-3.29) were not significant. For progression of an existing thrombus or development of a new thrombus, the independent relative risks for ambulation and compression versus bed rest and compression (RR ¼ 0.39, 95% CI: 0.13-1.14) and for ambulation and compression versus bed rest alone (RR ¼ 0.56, 95% CI: 0.20-1.57) were also not significant. Conclusions: Given the clinical benefits of mobility, and because there was no significant difference between ambulation and bed rest for risk of developing a PE or development and progression of a new DVT in any of the studies, clinicians should be confident in prescribing ambulation in this population. Mots clé s : embolie pulmonaire, lever, marche, thrombose veineuse, thrombose veineuse profonde aiguëThe authors have no disclosures associated with this work.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Ambulation after Deep Vein Thrombosis: A Systematic Review

Anderson¹,

Overend²,

Godwin³

et al. 2009

Physiotherapy Canada

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Section: Editorialmentioning

confidence: 99%

“…Kiser et al underline that the patient should stay immobilized for at least 48 to 72 hours while treated with fully therapeutic dose of anticoagulants [12]. However, Juenger et al found in a randomized multicentre trial that strict bed rest for at least 5 days is not justified if adequate therapy with LMWH and adequate compression is assured [13].Finally, PTS is a major chronic complication of DVT that reduces quality of life and has important socioeconomic consequences. More than one-third of patients with DVT will develop PTS, and 5% to 10% of patients will develop severe PTS, which may manifest as venous ulceration [14].…”

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confidence: 99%

Mobilisation after Lower Limb Deep Vein Thrombosis and Post-Thrombotic Syndrome

Galyfos¹

2015

J Nov Physiother

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EditorialDeep vein thrombosis (DVT) is one of the commonest cardiovascular diseases, ranking third behind coronary artery disease and stroke [1]. Furthermore, it is one of the major causes for inhospital morbidity and mortality, leading to severe complications such as pulmonary embolism (PE), post-thrombotic syndrome (PTS) and even death [2]. Local damage to venous intima, venous stasis and hypercoagulability are major predisposing factors, and it is thought that two of these factors must be present for a DVT to develop [3].Physiotherapists frequently handle in-patients diagnosed with a DVT, and management of such patients has been controversial. For decades, conservative management of DVTs using strict immobilization was based on the theoretical assumption that early ambulation and active range of motion would cause the thrombus to dislodge proximally, migrating to the pulmonary circulation and causing a PE, possibly leading even to death [4]. However, this assumption has never been tested empirically. Moreover, such a conservative treatment approach of bed rest can lead to secondary complications and can thus be detrimental for patients [4].Concerning proper management, immediate initiation of anticoagulation, and especially low molecular weight heparins (LMWH), has been proved to be the most important first-line treatment, and therefore, is recommended for acute DVT by the latest Guidelines (Level 2B) [5]. Anticoagulants also decrease the risk for subsequent PE and the incidence of thrombi propagation [6]. However, the same Guidelines underline also the importance of early ambulation over initial bed rest (Grade 2C), as well as the preference of treatment at home instead of in-hospital treatment (Grade 1B) [5]. Additionally, many systematic reviews conclude that there is no evidence proving that ambulation by anticoagulated DVT patients in the home setting increases the risk of PE development [4,7]. Aissaoui et al. showed in their recent meta-analysis that early ambulation in patients with DVT with or without PE was not associated with increased risk for DVT progression, new PE or even death [8]. Hence, experimental data also show that even exercise does not increase the risk for new PE, regardless of thrombus status [9]. Therefore, clinicians should be confident in prescribing ambulation in this population.Fear of PE is the main rationale for bed rest, while pain and swelling are expected to resolve faster during leg elevation. However, the rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression [10]. Immediate multilayer compression bandaging in the acute phase of DVT seems to be effective in reducing edema and complaints in the first week, although it has no effect on thrombus regression or valve incompetence within the following year [11]. Regarding the initiation time of ambulation after setting the diagnosis, there are controversial results in literature. Kiser et al. underline that the patient should stay immobilized for at least 48 to 72 hours whi...

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Compression therapy for prevention of post-thrombotic syndrome

Appelen¹,

Loo

Prins

et al. 2017

Cochrane Database of Systematic Reviews

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Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

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Mobilization versus immobilization in the treatment of acute proximal deep venous thrombosis: a prospective, randomized, open, multicentre trial

Cited by 43 publications

References 9 publications

Ambulation after Deep Vein Thrombosis: A Systematic Review

Ambulation after Deep Vein Thrombosis: A Systematic Review

Mobilisation after Lower Limb Deep Vein Thrombosis and Post-Thrombotic Syndrome

Compression therapy for prevention of post-thrombotic syndrome

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