The Role of Leg Compression in the Treatment of Deep Vein Thrombosis.

Up until today mobile outpatients are put into bed as soon as the diagnosis of deep vein thrombosis (DVT) is made. Fear of pulmonary embolism (PE) is the main rationale for bed-rest; additional arguments are pain and swelling which are expected to resolve faster during leg elevation. Based on previous work it is demonstrated that keeping mobile patients with acute DVT walking under exact anticoagulation does not increase the risk for symptomatic PE in comparison with bed-rest and that there is an immediate reduction of pain and swelling when good compression is applied and the patient is encouraged to walk. Immediate compression and walking seems also to reduce the incidence of a postthrombotic syndrome. One presumed mechanism of action of this adjunct treatment modality is the increase of shear stress in the microcirculation of the vein wall releasing anti-inflammatory and anti-coagulatory mediators.