Abstract 3116: Is Bed Rest Recommendation In The Management Of Patients With Pulmonary Embolism And/or Deep Vein Thrombosis Evidenced-based Medicine: A Meta-analysis.
Background: Treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) consists in an initial anticoagulation therapy with heparin followed by oral anticoagulants, that is associated with lower limb splint in case of deep vein thrombosis. In addition, patients are often recommended by some practitioners to be bedridden.
Methods: In order to perform a meta-analysis, we conducted an exhaustive bibliographic search of all studies that evaluated the interest of bed rest in patients with DVT and/or PE. We included randomized controlled studies and also prospective registry that compared bed rest versus ambulation, in addition to anticoagulant therapy, in patients with DVT and/or PE. We assessed as primary endpoint the occurence of a new PE; secondary endpoints were 1/ the occurence of a new PE or DVT, 2/ the occurence of a new PE or total mortality.
Results: 5 studies were included, corresponding to 3056 patients. When compared to bed rest, early ambulation was not associated with an increased risk of a new PE occurrence (RR 1.03; 95% CI [0.63–1.66], p = 0.92). Moreover, when considering new PE and overall mortality as endpoint, there was a trend for lesser events in the ambulation group (RR 0.77; 95%CI [0.52–1.15], p=0.21).
Conclusion: Bed rest recommendation has no beneficial effect as an adjunctive therapy, when compared to early ambulation, in patients with DVT and/or PE. Moreover, such a strategy may result in prolonged in-hospital stay and limit the possibility of treatment at home.