Zusammenfassung
Bei Patienten mit akuter tiefer Beinvenenthrombose ergaben einige Studien ein besseres klinisches Ergebnis mit Gehübungen unter guter Kompression als mit Bettruhe. Wiederholte Lungenszintigraphien haben kein erhöhtes Risiko für neue Lungenembolien gezeigt. Es kam zu einem rascheren und ausgeprägteren Rückgang von Schmerzen und Beinschwellung sowie zu einer Verbesserung der Lebensqualität. Sofortige Mobilisierung unter Kompression schränkt die Thrombuspropagation ein und hat einen positiven Einfluss bezüglich der Entwicklung eines postthrombotischen Syndroms. Patienten, die für eine Heimtherapie ausgewählt werden, sollten nicht nur über die Injektionstechnik der Therapiedosis ihres niedermolekularen Heparins unterrichtet werden, sondern auch angehalten werden, mit guter Kompression viel zu gehen. Die moderne antithrombotische Behandlung von mobilen Patienten mit akuter Beinvenenthrombose sollte niedermolekulares Heparin und sofortige Gehübungen unter guter Kompression beinhalten.
Abstract
For patients with acute deep vein thrombosis, studies have shown a better clinical outcome with walking exercises under good compression than with bed rest. Repeated lung scans did not show an increased risk of new pulmonary embolism. There was a faster and more intense reduction of pain and swelling and a clear quality of life benefit. Immediate ambulation with compression reduces the propagation of thrombi and has a positive impact on the development of a post-phlebitic syndrome. Patients selected for home therapy should not only be instructed on how to inject their therapeutic dose of low molecular weight heparin but should also be educated to walk around with good compression. Modern anti-thrombotic management of mobile patients with acute venous thrombosis should include low molecular weight heparin and immediate ambulation in conjunction with appropriate compression therapy.
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Literatur
Allen C, Glasziou P, Del Mar C (1999) Bed rest: a potentially harmful treatment needing more careful evaluation. Lancet 354: 1229–1233
Arcelus JI, Caprini JA, Monreal M, Suarez C, Gonzalez-Fajardo J (2003) The management and outcome of acute venous thromboembolism: a prospective registry including 4011 patients. J Vasc Surg 38: 916–22
Aschwanden M, Labs KH, Engel H et al. (2001) Acute deep vein thrombosis: early mobilization does not increase the frequency of pulmonary embolism. Thromb Haemost 85: 42–46
Blättler W, Gerlach HE (2005) Implementation of outpatient treatment of deep-vein thrombosisin private practices in Germany. Eur J Vasc Endovasc Surg 30: 319–324
Blättler W, Partsch H (2003) Leg compression and ambulation is better than bed rest for the treatment of the symptoms of acute deep venous thrombosis. Int Angiol 22: 393–400
Brandjes DP, Büller HR, Heijboer H et al. (1997) Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 349: 759–762
Breddin HK, Hach-Wunderle V, Nakov R, et al. (2001) Effects of a low-molecular-weight heparin on thrombus regression and recurrent thromboembolism in patients with deep-vein thrombosis. N Engl J Med 344: 626–631
Büller HR, Agnelli G, Hull RD et al. (2004) Antithrombotic therapy for venous thromboembolic disease. Chest 126: 401S–428S
Egermayer P (2001) The effects of heparin and oral anticoagulants on thrombus propagation and prevention ofthe postphlebitic syndrome : a critical review of the literature. Prog Cardiovasc Dis 44: 69–80
Fischer H (1910) Eine neue Therapie der Phlebitis. Med Klin 30: 1172–1180
Geerts WH, Pineo GF, Heit JA et al. (2004) Prevention of venous thromboembolism. Chest 126: 338S-400S
Huisman MV, Büller HR, ten Cate JW et al. (1989) Unexpected high prevalence of silent pulmonary embolism in patients with deep venous thrombosis. Chest 95: 498–502
Hull RD, Raskob GE, Hirsh J et al. (1986) Continuous intravenous heparin compared with intermittent subcutaneous heparin in the initial treatment of proximal-vein thrombosis. N Engl J Med 315: 1109–1114
Kirchmaier CM, Wolf H, Schäfer H et al. (1998) Efficacy of a low molecular weight heparin administered intravenously or subcutaneously in comparison with intravenous unfractionated heparin in the treatment of deep venous thrombosis. Int Angiol 17: 135–145
Koopman MMW, Prandoni P, Piovella F et al. (1996) Treatment of venous thrombosis with intravenous unfractionated heparin administered in the hospital as compared with subcutaneous low-molecular-weight heparin administered at home. N Engl J Med 334: 682–687
Levine M, Gent M, Hirsh J et al. (1996) A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med 334: 677–681
Martin M (1993) PHLECO: a multicenter study of the fate of 1647 hospital patients treated conservatively without fibrinolysis and surgery. Clin Investig 71(6): 471–747
Mostbeck A, Partsch H, Köhn H et al. (1980) Lungenembolie bei Bein-Beckenvenenthrombose: Ergebnisse einer prospektiven Studie. Diagnostik, Häufigkeit, nuklearmedizinisches und klinisches Erscheinungsbild. Wien Klin Wochenschr 92: 464–471
Panis LJ, Kolbach DN, Hamulyak K, Prins MH (2004) Identifying inappropriate hospital stay in patients with venous thromboembolism. Eur J Intern Med 15: 39–44
Partsch H, Blättler W (2000) Compression and walking versus bed-rest in the treatment of proximal deep venous thrombosis with low-molecular-weight heparin. J Vasc Surg 32: 861–869
Partsch H, Kaulich H, Mayer W (2004) Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome. Int Angiol 23: 206–212
Partsch H (2002) Bed rest versus ambulation in the initial treatment of patients with proximal deep vein thrombosis. Curr Opin Pulm Med 8: 389–393
Partsch H (2001) Therapy of deep vein thrombosis with low molecular weight heparin, leg compression and immediate ambulation. Vasa 30: 195–204
Prandoni P, Lensing AW, Prins MR (1998) Long-term outcomes after deep venous thrombosis of the lower exrtremities. Vasc Med 3: 57–60
Prandoni P, Lensing AW, Prins MH et al. (2004) Below- knee elastic compression stockings to prevent the post-thrombotic syndrome. Ann Intern Med 141: 249–56
Schellong SM, Schwarz TH, Krapp J et al. (1999) Bed rest in deep vein thrombosis and the incidence of scintigraphic pulmonary embolism. Thromb Haemost 82: 127–129
Schraibman IG, Milne AA, Royle EM (2001) Home versus in-patient treatment for deep vein thrombosis (Cochrane Review). In: The Cochrane Database of Systematic Reviews; Issue 2 Art No CD003076
Schulman (1988) Studies on the medical treatment of deep vein thrombosis. Acta Med Scand (Suppl) 704
Wells PS (2001) Outpatient treatment of patients with deep-vein thrombosis or pulmonary embolism. Curr Opin Pulmon Med 7: 360–364
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In Anlehnung an: Partsch H (2005) Ambulation and compression after deep vein thrombosis: dispelling myths. Semin Vasc Surg 18: 148–152.
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Partsch, H. Ambulatorische Therapie der tiefen Venenthrombose und die Wertigkeit der Kompression. Gefässchirurgie 11, 22–27 (2006). https://doi.org/10.1007/s00772-005-0436-x
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DOI: https://doi.org/10.1007/s00772-005-0436-x