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

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.