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
