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Early ambulation, bed rest provide similar outcomes for patients with DVT, anticoagulation
Patients with deep vein thrombosis receiving anticoagulation did not experience new pulmonary embolism, disease worsening or disease-related deaths with early ambulation compared with bed rest, according to a meta-analysis published in PLoS One.
Further, among patients who suffered moderate-to-severe pain initially, early ambulation led to better outcomes regarding remission of acute pain in the affected limb, according to researchers.
“Compared to conventional bed rest treatment, early ambulation was not associated with a higher incidence of PE, progression of [deep vein thrombosis] or [deep vein thrombosis]-related death in acute [deep vein thrombosis] patients with effective anticoagulation regimen,” the researchers wrote.
Zhenlei Liu, a student at Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China, with Yongjun Li, MD, PhD, of the department of vascular surgery, Peking Union Medical College Hospital, and colleagues analyzed 13 studies involving a total of 3,269 patients found through a search of Medline, PubMed, Cochrane Library and three Chinese databases. Randomized controlled trials, prospective and retrospective cohort studies were considered.
The investigators examined the incidence of new pulmonary embolism (PE), progression of deep vein thrombosis (DVT) and DVT-related deaths, as well as the extent of remission of pain and edema in patients managed with early ambulation versus bed rest, in addition to standard anticoagulation.
Compared with bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT-related deaths (risk difference = – 0.03; 95% CI, – 0.05 to – 0.02; z = 1.24). In patients who suffered moderate or severe pain initially, better remission of acute pain was observed with early ambulation (standard mean difference = 0.42; 95% CI, 0.09 to 0.74; z = 2.52).
Alleviation of edema could not be solidly determined due to significant heterogeneity among the few studies.
“More studies are needed to confirm the benefit with respect to reduction of edema, incidence of [post thrombotic syndrome], as well as extent of recanalization of thrombotic veins,” the researchers wrote. – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.