Acute deep vein thrombosis : early ambulation vs bed rest in reducing the risk of pulmonary embolism development in patients on anticoagulants

Abstract

Background: Venous thromboembolism (VTE) is a collective term which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE) (Di Nisio et al., 2016). It is estimated that the incidence rate of PE in European countries is 0.95 per 1000 persons per year (Agnelli et al., 2007). Bed rest has been the foundation of the management of DVT to prevent PE for quite some time; however, it is not yet evidence based. Therefore, this study analysed the effect of early ambulation to prevent the risk of PE. Research Question: In patients suffering from Deep Vein Thrombosis (DVT) who are on anticoagulant medication, does early ambulation compared to bed rest prevent the risk of having Pulmonary Embolism (PE)? PICO Elements: The Population (P) studied were patients with DVT who are on anticoagulant therapy. The Intervention (I) observed was performing early ambulation in Comparison (C) with bed rest, while the final desired Outcome (O) was the decreased risk of having PE. Method: A detailed systematic literature search was conducted using different electronic databases. The inclusion criteria used were peer-reviewed articles that were published in English from 2008 onwards. Systematic reviews (SRs), meta-analyses, randomised controlled trials (RCTs), or cohort studies were eligible for inclusion. Five studies were retrieved (2 Systematic Reviews, 2 Meta-Analyses, and 1 Cohort Study). Relevant CASP tools were utilised to critically appraise the literature. Ethical issues were duly considered. Results: From the appraised articles, it was generally concluded that early ambulation is effective in reducing the risks of PE. Although all the studies were consistent, there were still several methodological limitations and differences present. It was thus concluded that the results need to be interpreted with caution. Implications and Recommendations: The need for further research was identified in order to determine the effectiveness of the intervention, as well as incentives to conduct local studies. The requirement for further education for both health care professionals and patients on early ambulation in reducing the risks of PE was discussed. It was additionally concluded that there is the need for the implementation of evidence-based protocols on early ambulation.