Blättler W, Partsch H
Center for Vascular Diseases, Angio Bellaria, Zurich, Switzerland.
Int Angiol. 2003 Dec;22(4):393-400.
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.
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.
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.
Leg compression combined with walking is the better alternative to bed rest for the treatment of symptomatic outpatients with proximal DVT.
使用低分子量肝素和维生素K拮抗剂治疗急性深静脉血栓形成（DVT）可降低血栓进展和肺栓塞的风险，但对体征和症状无直接影响。我们探讨了与卧床休息相比，增加压迫和行走是否会导致临床症状更快改善。
53例有症状的近端DVT门诊患者，除达肝素和苯丙香豆素外，随机接受以下治疗：使用硬的无弹性绷带（n = 18）、弹性压迫袜（n = 18），两者均联合立即有意走动，或不进行任何压迫的卧床休息（n = 17）。我们在9天内评估每日行走距离、健康状况、生活质量、疼痛、肿胀和临床评分。在第0天和第9天进行肺部扫描和腿部超声检查。
在压迫组中，行走距离随时间增加，平均达到每天4公里。与卧床休息相比，压迫组的健康状况和与DVT相关的生活质量改善明显更快且更显著（压迫袜组p<0.05，绷带组p<0.001）。所有组中，通过视觉模拟量表监测的疼痛随时间呈线性下降（p<0.001）。组间存在显著差异（p<0.01），绷带的效果最佳。通过激发试验评估的疼痛在卧床休息组第3天时减轻了一半，但在随后6天中持续存在。采用压迫治疗时，在第３天时疼痛减轻至接近基线水平。压迫治疗几乎完全消除了肿胀，临床评分也比卧床休息改善得更多（p<0.001）。超声检查显示，与卧床休息相比，压迫组血栓进展的频率更低且程度更轻。重复肺部扫描时新发肺栓塞无差异。
对于有症状的近端DVT门诊患者，腿部压迫联合行走是比卧床休息更好的治疗选择。
Zotero 插件