ORIGINAL ARTICLES   

International Angiology 2004 September;23(3):206-12

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Immediate mobilisation in acute vein thrombosis thrombosis reduces post-thrombotic syndrome

Partsch H., Kaulich M., Mayer W.

Department of Dermatology, Wilhelminen Hospital, Vienna, Austria

Aim. To inves­ti­gate the ­effect of com­pres­sion and imme­di­ate ambu­la­tion in the acute stage of deep vein throm­bo­sis (DVT) on the devel­op­ment of post­throm­bot­ic syn­drome (PTS).
Meth­ods. ­Design: fol­low-up study of ­patients who pre­vi­ous­ly have been ­enrolled in a ran­dom­ized con­trolled trial. Set­ting: out­pa­tient depart­ment of a muni­cip­i­al hos­pi­tal. Sub­jects and inter­ven­tions: a fol­low-up was per­formed 2 years after 53 ­patients with acute prox­i­mal DVT had been ­enrolled into a ran­dom­ized con­trolled trial, com­par­ing bed rest and no com­pres­sion (n=17), Unna boot band­ag­es plus walk­ing (n=18) and com­pres­sion stock­ings plus walk­ing (n=18). Tele­phone inter­views could be con­duct­ed with 11 ­patients, 37 ­patients could be rein­ves­ti­gat­ed by inde­pen­dent observ­ers (11 from the bed-rest group, 13 from the band­age group and 13 from the stock­ing group). Com­pres­sion stock­ings up to the time of the fol­low-up were worn by 8/11 (73%) of the bed-rest ­patients and by 13/26 (50%) of the ­mobile ­patients. Main out­come meas­ures: clin­i­cal and ­venous ­duplex inves­ti­ga­tion, pain assess­ment using vis­u­al ana­logue scale and Low­en­berg test, leg cir­cum­fer­ence, clin­i­cal “PTS-score” com­bin­ing 5 sub­jec­tive symp­toms with 6 objec­tive signs (Vil­lal­ta-Pran­do­ni-scale).
­Results. ­Duplex inves­ti­ga­tion of the deep veins and pain assess­ment by vis­u­al ana­logue scale ­showed no sig­nif­i­cant dif­fer­enc­es ­between the ­groups. Nine out of 11 ­patients after bed rest, but only 16/26 in the ­mobile ­groups ­showed a larg­er calf cir­cum­fer­ence on the dis­eased leg (n.s.). ­Judged by the Vil­lal­ta-Pran­do­ni-scale a sig­nif­i­cant­ly bet­ter out­come could be found in the ­mobile group (mean score 5.1) than in the bed-rest group (mean score 8.2), (p<0.01). (“Mild PTS”= score 5-14, “­severe PTS” score ≥15). Eight­een out of 26 ­mobile ­patients, but only 2/11 bed-rest ­patients had a score ≤5 (“no PTS”).
Con­clu­sion. Imme­di­ate mobil­isa­tion with com­pres­sion in the acute stage of DVT reduc­es the inci­dence and the sever­ity of PTS.