Ambulation after deep vein thrombosis: a systematic review.

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 = 0.63, 95% CI: 0.34-1.19) and for ambulation and compression versus bed rest alone (RR = 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 = 0.39, 95% CI: 0.13-1.14) and for ambulation and compression versus bed rest alone (RR = 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.