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

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).

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 = or > 15). Eighteen out of 26 mobile patients, but only 2/11 bed-rest patients had a score = or < 5 (''no PTS'').

CONCLUSIONS

Immediate mobilisation with compression in the acute stage of DVT reduces the incidence and the severity of PTS.