Bed Rest or Ambulation in the Initial Treatment of Patients With Acute Deep Vein Thrombosis or Pulmonary Embolism

Trujillo‐Santos, Javier; Perea-Milla, Emilio; Jiménez-Puente, Alberto; Sánchez‐Cantalejo, Emilio; Toro, J. del; Grau, E; Monréal, Manuel

doi:10.1378/chest.127.5.1631

Cited by 70 publications

(21 citation statements)

References 11 publications

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“…In 2005, patients with VTE and recent major bleeding prior to VTE diagnosis were studied and found to have poorer clinical outcomes compared with those who had not experienced recent major bleeding 23. Study of the influence of overweight,24 and early ambulation in the treatment of VTE demonstrated no influence of extreme overweight and bed rest in patients presenting with acute VTE 25…”

Section: Activities Of Vte Registry In Western Countriesmentioning

confidence: 99%

Current Status of the Korean Venous Thromboembolism Registry

2011

Yonsei Med J

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The Korean venous thromboembolism (VTE) registry, which was initiated by the Working Parties of Korean Society on Thrombosis and Hemostasis, and the Korean Society of Hematology, is a web-based multicenter registry (http://kdvt.chamc.co.kr) for recruiting consecutive VTE patients. The aim of the registry is to prospectively collect data on the epidemiology and clinical outcomes of VTE from a large, unselected cohort of patients, and to provide data on the true incidence and management of VTE in the real-world. By the end of 2007, the starting year of the registry, 840 patients were registered. By the end of 2008, 1,121 were registered, with 1,289 by the end of 2009, and 1,463 by April 2010 from 11 hospitals. The first report on the epidemiologic characteristics of 596 consecutive VTE patients was released in October 2007.

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Section: Activities Of Vte Registry In Western Countriesmentioning

confidence: 99%

Current Status of the Korean Venous Thromboembolism Registry

2011

Yonsei Med J

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“…The Registro Informatizado de la Enfermedad Tromboembó lica (RIETE) initiative is an ongoing, international (Spain, France, Italy, Israel and Argentina), multicentre, prospective registry of consecutive patients presenting with symptomatic acute venous thromboembolism (VTE) confirmed by objective tests [12][13][14][15][16]. The aim of the present study was to compare the predictive value of the three clinical parameters (shock index, SBP ,100 mmHg and SBP ,90 mmHg) on 30-day mortality in all patients with acute PE.…”

mentioning

confidence: 99%

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Otero

Trujillo‐Santos²,

Cayuela³

et al. 2007

Eur Respir J

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Patients with acute pulmonary embolism (PE) presenting with haemodynamic instability have the worst prognosis. However, what is understood by haemodynamic instability has not been clearly defined.The Registro Informatizado de la Enfermedad Tromboembólica (RIETE) is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute deep vein thrombosis or PE. The present authors compared the predictive value of a systolic blood pressure (SBP) value of ,100 mmHg and ,90 mmHg and the shock index (cardiac frequency divided by SBP) on 30-day mortality in consecutive patients with PE.As of May 2006, 6,599 patients with PE were enrolled in the study. Of these, 417 (6.3%) died within 30 days: 153 of the initial PE, 29 of recurrent PE and 235 due to other causes. Of the 417 individuals who died, 127 (30%) had a positive shock index, 60 (14%) had SBP ,100 mmHg and 33 (7.9%) had SBP ,90 mmHg. On multivariate analysis any of the three parameters were independently associated with an increased mortality. The shock index had a higher sensitivity (30.5 versus 14.4 and 7.9% for SBP ,100 mmHg and ,90 mmHg, respectively) but lower specificity (86.3 versus 93.0 and 96.6).All three measures of haemodynamic instability are independent predictors of 30-day mortality. However, while the shock index had the highest sensitivity, a systolic blood pressure value ,90 mmHg had the highest specificity.

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“…[22][23][24][25][26] In a large prospective observational registry study of 2,650 patients with acute DVT or PE, Trujillo-Santos et al reported patient outcomes for bed rest compared to early ambulation. 22 They found no difference in the incidence of PE when patients were ambulated (9 of the 1,435 patients on bed rest and 6 of the 1,215 early ambulators developed a new PE). One limitation of their study was that the patients prescribed bed rest tended to be sicker at baseline.…”

Section: Discussionmentioning

confidence: 99%

Ambulation after Deep Vein Thrombosis: A Systematic Review

Anderson¹,

Overend²,

Godwin³

et al. 2009

Physiotherapy Canada

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Purpose: To systematically review the effects of early ambulation on development of pulmonary embolism (PE) and progression or development of a new thrombus in patients with acute deep vein thrombosis (DVT). Methods: Medline, PubMed, CINAHL, EMBASE, PEDro, and Cochrane Library databases were searched from inception to June 2008. Study quality was appraised using the Jadad and PEDro scales. Meta-analyses were reported as relative risks (RR) and 95% confidence intervals (CI). Results: Four randomized trials were accepted. For development of a PE, the pooled relative risks for ambulation and compression versus bed rest and compression (RR ¼ 0.63, 95% CI: 0.34-1.19) and for ambulation and compression versus bed rest alone (RR ¼ 1.36, 95% CI: 0.57-3.29) were not significant. For progression of an existing thrombus or development of a new thrombus, the independent relative risks for ambulation and compression versus bed rest and compression (RR ¼ 0.39, 95% CI: 0.13-1.14) and for ambulation and compression versus bed rest alone (RR ¼ 0.56, 95% CI: 0.20-1.57) were also not significant. Conclusions: Given the clinical benefits of mobility, and because there was no significant difference between ambulation and bed rest for risk of developing a PE or development and progression of a new DVT in any of the studies, clinicians should be confident in prescribing ambulation in this population. Mots clé s : embolie pulmonaire, lever, marche, thrombose veineuse, thrombose veineuse profonde aiguëThe authors have no disclosures associated with this work.

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Bed Rest or Ambulation in the Initial Treatment of Patients With Acute Deep Vein Thrombosis or Pulmonary Embolism

Cited by 70 publications

References 11 publications

Current Status of the Korean Venous Thromboembolism Registry

Current Status of the Korean Venous Thromboembolism Registry

Haemodynamically unstable pulmonary embolism in the RIETE Registry: systolic blood pressure or shock index?

Ambulation after Deep Vein Thrombosis: A Systematic Review

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