Download PDF
Thromb Haemost 2001; 85(01): 42-46
DOI: 10.1055/s-0037-1612901
Review Article
Schattauer GmbH

Acute Deep Vein Thrombosis: Early Mobilization Does not Increase the Frequency of Pulmonary Embolism

Markus Aschwanden
1   Department of Angiology and the Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Karl-Heinz Labs
1   Department of Angiology and the Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Hermann Engel
2   Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Andreas Schwob
1   Department of Angiology and the Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Christina Jeanneret
1   Department of Angiology and the Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Jan Mueller-Brand
2   Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
,
Kurt A. Jaeger
1   Department of Angiology and the Institute of Nuclear Medicine, University of Basel Medical School, University Hospitals Basel, Switzerland
› Author Affiliations
Further Information

Publication History

Received 03 March 1999

Accepted after resubmission 07 June 2000

Publication Date:
08 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Outpatient treatment for acute symptomatic deep vein thrombosis (DVT) was shown to be safe for most patients. However, little is known whether patients treated on an outpatient basis were ambulating or predominantly resting, a factor which may be decisive for the outcome. In the present study 129 DVT patients were randomized to either strict immobilization for 4 days or to ambulate for ≥4 hours per day under supervision in order to show, whether the old concept of temporary immobilization is superior to early mobilization or not. The DVT diagnosis was based on duplex sonography; all patients were screened for PE at baseline and at day 4 by pulmonary ventilation-perfusion scanning, and were followed up for a total of 3 months. Clinically, changes in leg circumferences and leg pain were evaluated. The frequency of PE at baseline was 53.0% and 44.9% in the immobile and the mobile groups, respectively. During the 4 days observation period new PEs were found in 10.0% and in 14.4% of the immobilized and the ambulating patients (Δ 4.4%; 95% CI −0.5 to 13.8; χ2 = 0.596, p = 0.44). The occurrence of new PE was related to the presence of PE at baseline but not to other potential predictors. The magnitude of a decrease in leg circumferences and leg pain was comparable in both groups. No patient died during the 4 day observation period. The total 3 month mortality rate was 3.9% (5 patients; 2 from the immobile, 3 from the ambulating group). All 5 patient suffered from malignancies. The results of this study show in accordance with the trial hypothesis that, regarding the frequency of PE, immobilization is not superior to early mobilization, suggesting that early mobilization is safe.

Keywords

Deep vein thrombosis - pulmonary embolism - early mobilization
 

  • References

  • 1 Gould MK, Dembitzer AD, Doyle RL, Hastie TJ, Garber AM. Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A meta-analysis of randomized, controlled trials. Ann Intern Med 1999; 130: 800-9.
    CrossrefPubMedGoogle Scholar
  • 2 Levine M, Gent M, Hirsh J, Leclerc J, Anderson D, Weitz J, Ginsberg J, Turpie AG, Demers C, Kovacs M, Geerts W, Kassis J, Desjardins L, Cusson J, Cruickshank M, Powers P, Brien W, Haley S, Willan A. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 1996; 334: 677-81.
    CrossrefPubMedGoogle Scholar
  • 3 Koopman MM, Prandoni P, Piovella F, Ockelford PA, Brandjes DP, van der Meer J, Gallus AS, Simonneau G, Chesterman CH, Prins MH, Bossuyt PM, de Haes H, van den Belt AG, Sagnard L, d’Azemar P, Buller HR. Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. The Tasman Study Group. N Engl J Med 1996; 334: 682-7.
    CrossrefPubMedGoogle Scholar
  • 4 Lindmarker P, Holmstrom M. Use of low-molecular-weight heparin (dalteparin), once daily, for the treatment of deep vein thrombosis. A feasibility and health economic study in an outpatient setting. J Intern Med 1996; 240: 395-401.
    CrossrefPubMedGoogle Scholar
  • 5 Harrison L, McGinnis J, Crowther M, Ginsberg J, Hirsh J. Assessment of outpatient treatment of deep-vein thrombosis with low-molecular-weight heparin. Arch Intern Med 1998; 158: 2001-3.
    CrossrefPubMedGoogle Scholar
  • 6 Partsch H, Oburger K, Mostbeck A, König B, Köhn H. Frequency of pulmonary embolism with pelvic vein thrombosis: a prospective study. J Vasc Surg 1992; 16: 715-22.
    CrossrefPubMedGoogle Scholar
  • 7 Sostman HD, Coleman RE, DeLong DM, Newman GE, Paine S. Evaluation of revised criteria for ventilation-perfusion scintigraphy in patients with suspected pulmonary embolism. Radiology 1994; 193: 103-7.
    CrossrefPubMedGoogle Scholar
  • 8 Fraser JD, Anderson DR. Deep venous thrombosis: recent advances and optimal investigation with US. Radiology 1999; 211: 9-24.
    CrossrefPubMedGoogle Scholar
  • 9 Miller N, Satin R, Tousignant L, Sheiner NM. A prospective study comparing duplex scan and venography for diagnosis of lower extremity deep vein thrombosis. Cardiovasc Surg 1996; 4: 505-8.
    CrossrefPubMedGoogle Scholar
  • 10 Montefusco von Kleist CM, Bakal C, Sprayregen S, Rhodes BA, Veith FJ. Comparison of duplex sonography and ascending contrast venography in the diagnosis of venous thrombosis. Angiology 1993; 44: 169-75.
    CrossrefPubMedGoogle Scholar
  • 11 De Valois JC, van Schaik CC, Verzijlbergen F, van Ramshorst B, Eikelboom BC, Meuwissen OJ. Contrast venography: from gold standard to “golden backup” in clinically suspected deep vein thrombosis. Eur J Radiol 1990; 11: 131-7.
    CrossrefPubMedGoogle Scholar
  • 12 Partsch H, Kechavarz B, Mostbeck A, Köhn H, Lipp C. Frequency of pulmonary embolism in patients who have iliofemoral deep vein thrombosis and are treated with once- or twice-daily low-molecular-weight heparin. J Vasc Surg 1996; 24: 774-82.
    CrossrefPubMedGoogle Scholar
  • 13 Partsch H, Kechavarz B, Köhn H, Mostbeck A. The effect of mobilisation of patients during treatment of thromboembolic disorders with low-molecular-weight heparin. Int Angiol 1997; 16: 189-92.
    PubMedGoogle Scholar
  • 14 Huisman MV, Buller HR, ten Cate JW, van Royen EA, Vreeken J, Kersten MJ, Bakx R. Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 1989; 95: 498-502.
    CrossrefPubMedGoogle Scholar
  • 15 Moser KM, LeMoine JR. Is embolic risk conditioned by location of deep venous thrombosis?. Ann Intern Med 1981; 94: 439-44.
    CrossrefPubMedGoogle Scholar
  • 16 Monreal M, Rey-Joly Barrosa C, Ruiz-Manzona J, Salvador-Tarrason R, Lafoz-Laval E, Viver-Manresa E. Asymptomatic pulmonary embolism in patients with deep vein thrombosis. Is it useful to take a lung scan to rule out this condition?. J Cardiovasc Surg (Torino) 1989; 30: 104-7.
    PubMedGoogle Scholar
  • 17 Albada J, Nieuwenhuis HK, Sixma JJ. Treatment of acute venous thromboembolism with low-molecular-weight heparin (Fragmin): Results of a double-blind randomized study. Circulation 1989; 80: 935-40.
    CrossrefPubMedGoogle Scholar
  • 18 The Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N Engl J Med 1997; 337: 657-62.
    CrossrefPubMedGoogle Scholar
  • 19 Porter JM, Moneta GL. Reporting standards in venous disease: An update. International consensus committee on chronic venous disease. J Vasc Surg 1995; 21: 635-45.
    CrossrefPubMedGoogle Scholar