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International Angiology 2003 December;22(4):393-400


lingua: Inglese

Leg compression and ambulation is better than bed rest for the treatment of acute deep venous thrombosis

Blättler W. 1, Partsch H. 2

1 Center for Vascular Diseases, Angio Bellaria, Zurich, Switzerland 2 Department of Dermatology, Wilhelminenspital, Vienna, Austria


Aim. Treat­ment of acute deep venous thrombosis (DVT) with low-molec­u­lar-­weight hep­ar­in and vita­min K-antag­o­nists reduc­es the risk of throm­bus pro­gres­sion and pul­mo­nary embo­lism but has no imme­di­ate ­effect on signs and symp­toms. We ­addressed the ques­tion wheth­er add­ing com­pres­sion and walk­ing would lead to a more rapid clin­i­cal improve­ment than bed rest.
Meth­ods. Fifty-three symp­to­mat­ic out­pa­tients with prox­i­mal DVT were ran­dom­ly treat­ed, in addi­tion to dal­tep­ar­in and phen­pro­cou­mon, with ­either firm inelas­tic band­ag­es (n=18), elas­tic com­pres­sion stock­ings (n=18), both com­bined with imme­di­ate delib­er­ate ambu­la­tion, or bed rest with­out any com­pres­sion (n=17). We ­assessed daily walk­ing dis­tance, well-being, qual­ity of life, pain, swell­ing and clin­i­cal ­scores over a peri­od of 9 days. Lung scans and ultra­sound of the leg were per­formed on days 0 and 9.
­Results. In the com­pres­sion ­groups the walk­ing dis­tance ­increased with time to 4 km/day on aver­age. Improve­ment of well-being and DVT-relat­ed qual­ity of life was sig­nif­i­cant­ly fast­er and more pro­nounced with com­pres­sion than with bed rest (p<0.05 for stock­ings, p<0.001 for band­ag­es). Pain mon­i­tored by vis­u­al ana­logue scale ­decreased with time in a lin­e­ar pat­tern in all ­groups (p<0.001). There was a sig­nif­i­cant dif­fer­ence ­between the ­groups (p<0.01), the best ­effect being ­achieved with band­ag­es. Pain ­assessed by a prov­o­ca­tion test was ­reduced by half on day 3 with bed rest but ­remained con­stant­ly ­present over the sub­se­quent 6 days. With com­pres­sion it was ­reduced to near base­line on day 3. Swell­ing was ­almost com­plete­ly ­removed with com­pres­sion and clin­i­cal ­scores also ­improved more than with bed rest (p<0.001). Throm­bus pro­gres­sion, as stud­ied with ultra­sound, was less fre­quent and less pro­nounced in the com­pres­sion ­groups than with bed rest. There was no dif­fer­ence of new pul­mo­nary embo­lism on ­repeat lung scans.
Con­clu­sion. Leg com­pres­sion com­bined with walk­ing is the bet­ter alter­na­tive to bed rest for the treat­ment of symp­to­mat­ic out­pa­tients with prox­i­mal DVT.

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