Level 2: Mid-level evidence

Early mobilization was associated with a lower incidence of deep venous thrombosis (DVT) progression in a randomized trial of 103 patients hospitalized for proximal DVT, but the results did not reach statistical significance (Curr Med Res Opin. 2006;22:593-602). Patients were randomized to five days of strict bed rest vs. early mobilization; those with symptomatic pulmonary embolism (PE) were excluded. All patients were treated with dalteparin (Fragmin) and compression bandages; follow-up at 10-12 days included color duplex sonography or phlebography to detect DVT progression and perfusion/ventilation scanning or spiral CT to detect PE.

Participant enrollment was terminated early due to reluctance of study centers to continue randomizing patients to immobilization.

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Comparing bed rest vs. early mobilization, 50% vs. 48% had scintigraphic PE at baseline, 20% vs. 7.7% had progression of DVT based on follow-up imaging (P =.088), 10% vs. 1.9% had “clinically relevant [not clearly defined] or symptomatic pulmonary embolism” (P =.109), and 6% vs. 1.9% had nosocomial infection and/or serious adverse event (not significant). There were no deaths in either group.

Based on a previous randomized trial (N = 129), walking is not clearly harmful during initial treatment of DVT (Thromb Haemost. 2001;85:42-46). Patients in this study were randomized to strict immobilization for four days vs. ambulation for at least four hours per day. Screening for PE with ventilation-perfusion scanning was done at baseline and at four days; patients were followed clinically (leg circumferences and leg pain) for three months.

Comparing immobilization vs. ambulation, 53% vs. 45% had PE at baseline and 10% vs. 14.4% had a new PE at four days (not significant but 95% CI approaches NNH 7 for ambulation). However, the baseline differences in rates of PE may affect rates of new PE.