Bed Rest or Ambulation in the Initial Treatment of Patients With Acute Deep Vein Thrombosis or Pulmonary Embolism

Findings From the RIETE Registry


      Traditionally, many patients with acute deep vein thrombosis (DVT) are treated not only by anticoagulation therapy but additionally by strict bed rest, which is aimed at reducing the risk of pulmonary embolism (PE) events. However, this risk has not been subjected to empirical verification.

      Patients and methods

      The Registro Informatizado de la Enfermedad TromboEmbólica is a Spanish registry of consecutively enrolled patients with objectively confirmed, symptomatic acute DVT or PE. In this analysis, the clinical characteristics, details of anticoagulant therapy, and clinical outcomes of enrolled patients with and without strict bed rest prescribed during the first 15 days were compared. Patients in whom ambulation was not possible were not included in this analysis.


      A total of 2,650 patients entered the study (DVT, 2,038 patients; PE, 612 patients). Of these patients, 1,050 DVT patients (52%) and 385 PE patients (63%) were prescribed strict bed rest. New events of symptomatic, objectively confirmed PE developed during the 15-day study period in 11 patients with DVT (0.5%) and 4 patients with PE (0.7%). Five of these 15 patients (33%) died as a result of their PE. Age < 65 years (odds ratio [OR], 3.1; 95% confidence interval [CI], 0.98 to 11) and cancer (OR, 3.0; 95% CI, 0.98 to 9.1) were associated with an increased rate of new PEs. There were not significant differences between bedridden and ambulant patients in terms of new PE events, fatal PE, or bleeding complications.


      Our findings confirm those from previous reports suggesting that bed rest has no influence on the risk of developing PE among patients with acute DVT of the lower limbs. In addition, our findings show for the first time the lack of influence of bed rest even in patients presenting with acute submassive PE.



      CI (confidence interval), DVT (deep vein thrombosis), LMWH (low-molecular-weight heparin), OR (odds ratio), PE (pulmonary embolism), RIETE (Registro Informatizado de la Enfermedad TromboEmbólica), VTE (venous thromboembolism)
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        • Hyers TM
        • Agnelli G
        • Hull RD
        • et al.
        Antithrombotic therapy for venous thromboembolic disease.
        Chest. 2001; 119(suppl): 176S-193S
        • Ansell J
        • Hirsh J
        • Dalen J
        • et al.
        Managing oral anticoagulant therapy.
        Chest. 2001; 119(suppl): 22S-38S
        • Partsch H
        • Blättler W
        Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin.
        J Vasc Surg. 2000; 32: 861-869
        • Aschwanden M
        • Labs KH
        • Engel H
        • et al.
        Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism.
        Thromb Haemost. 2001; 85: 42-46
        • Schellong SM
        • Schwarz T
        • Kropp J
        • et al.
        Bed rest in deep vein thrombosis and the incidence of scintigraphic pulmonary embolism.
        Thromb Haemost. 1999; 82(suppl): 127-129
        • Arcelus JI
        • Monreal M
        • Caprini JA
        • et al.
        The management and outcome of acute venous thrombo-embolism: a prospective registry including 4,011 patients.
        J Vasc Surg. 2003; 38: 916-922
        • Monreal M
        • Suárez C
        • González-Fajardo JA
        • et al.
        Management of patients with acute venous thromboembolism: findings from the RIETE Registry.
        Pathophysiol Haemost Thromb. 2004; 33: 330-334
        • Monreal M
        • López L
        • Montero M
        • et al.
        Venous thromboembolism treatment in the elderly: findings from the RIETE Registry [abstract].
        Blood. 2003; 102: 166a
        • Monreal M
        • Kakkar AK
        • Caprini JA
        • et al.
        Is the natural history of venous thromboembolism different in surgical and non-surgical patients? Findings from the RIETE Registry [abstract].
        Blood. 2003; 102: 112b
        • Partsch H
        Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation.
        Vasa. 2001; 30: 195-204
        • Heit JA
        • Mohr DN
        • Silverstein MD
        • et al.
        Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study.
        Arch Intern Med. 2000; 160: 761-768
        • Douketis JD
        • Foster GA
        • Crowther MA
        • et al.
        Clinical risk factors and timing of recurrent venous thromboembolism during the initial 3 months of anticoagulant therapy.
        Arch Intern Med. 2000; 160: 3431-3436
        • Sorensen HT
        • Mellemkjaer L
        • Olsen JH
        • et al.
        Prognosis of cancers associated with venous thromboembolism.
        N Engl J Med. 2000; 343: 1846-1850
        • Prandoni P
        • Lensing AWA
        • Piccioli A
        • et al.
        Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis.
        Blood. 2002; 100: 3484-3488