What is the role of ambulation in the therapy of deep venous thrombosis (DVT)?

Updated: Jun 06, 2019
  • Author: Kaushal (Kevin) Patel, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Controversy exists regarding the role of ambulation in the therapy of deep venous thrombosis (DVT). A study by Partsch reviewed the myths surrounding immediate ambulation and compression in the patient with newly diagnosed DVT and concluded that early ambulation and compression is not associated with any significant risk of pulmonary embolism (PE). [161] It is well recognized from the older literature that almost 50% of patients with acute proximal DVT have evidence, based on V/Q pulmonary scanning, of asymptomatic PE at baseline. Analyzing the effect of ambulation and compression in this patient cohort focused on the development of a new PE, the relief of pain and swelling, and the reduction in the incidence and severity of postthrombotic syndrome (PTS).

The authors cited 2 small previous studies that demonstrated that the incidence of a new PE after initiation of anticoagulant therapy with a low-molecular-weight heparin (LMWH) did not increase significantly in patients treated with early ambulation and compression. They had previously reported their own prospective cohort study of 1289 patients with acute DVT treated as outpatients with LMWH, early ambulation, and compression. Partsch et al reported that only 77 of 1289 patients (5.9%) developed a new PE, only 6 of 1289 patients (0.4%) of these were symptomatic, and only 3 deaths (0.23%) were attributed to the PE. This was not significantly different than historical controls.


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