Defined — not being able to walk 30 feet (10 meters) at one time. Bathroom privileges or walking in the room are not considered ambulation. Walking this distance reduces the VTE risk by
50%Does ambulation modify venous thromboembolism risk in acutely ill medical patients?
Alpesh N Amin 1, Frederick Girard, Meyer M Samama
PMID: 20838741. DOI: 10.1160/TH10-04-0236
Abstract
In the US, ambulatory status is often a criterion for stopping prophylaxis for venous thromboembolism (VTE). In an analysis of the prophylaxis in MEDical patients with ENOXaparin (MEDENOX) trial, ambulatory status was assessed as outcome and patients grouped accordingly for further analysis. Rates of VTE and bleeding were evaluated. Using multivariate logistic regression, the relationships between thromboprophylaxis, VTE risk, and ambulatory status were assessed. Ambulatory status was reached in 607/1,084 patients, in a mean time of 4.4 days. Thromboprophylaxis was provided for 7.3 and 7.7 days in the ambulatory and non-ambulatory groups. Although VTE rates were lower in ambulatory patients, enoxaparin 40 mg once daily significantly reduced the risk of VTE vs. placebo in ambulatory (3.3% vs. 10.6%; relative risk [RR] = 0.31; 95% confidence interval [CI], 0.13-0.78; p=0.008) and non-ambulatory patients (9.0% vs. 19.7%; RR = 0.46; 95% CI, 0.23-0.91; p=0.02). Major bleeding was not significantly different between enoxaparin and placebo in either group. By multivariate regression analysis, VTE risk in ambulatory patients was lower with enoxaparin vs. placebo (odds ratio [OR] = 0.28; 95% CI, 0.11-0.74; p=0.01), but higher in patients with a history of VTE (OR = 3.74; 95% CI, 1.59-8.84; p=0.003) or cancer (OR = 2.12; 95% CI, 1.00-4.48; p=0.049). Despite timely mobilisation, patients who become ambulatory are at VTE risk and experience a significant risk reduction with enoxaparin 40 mg. Therefore, it is essential that ambulatory patients receive recommended thromboprophylaxis.
Reference:
Thromb Haemost. 2010 Nov;104(5):955-61. doi: 10.1160/TH10-04-0236. Epub 2010 Sep 13.
MOBILITY – BEDREST > 3 Days.
Defined — Same mobility distance as above. PE mortality increased for those immobile for >
Influence of recent immobilization and recent surgery on mortality in patients with pulmonary embolism
D Nauffal 1, M Ballester, R Lopez Reyes, D Jiménez, R Otero, R Quintavalla, M Monreal, RIETE Investigators
Collaborators,
PMID: 22726525. DOI: 10.1111/j.1538-7836.2012.04829.x
Abstract
Background: The influence of recent immobilization or surgery on mortality in patients with pulmonary embolism (PE) is not well known.
Methods: We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) data to compare the 3-month mortality rate in patients with PE, with patients categorized according to the presence of recent immobilization, recent surgery, or neither.
Results: Of 18,028 patients with PE, 4169 (23%) had recent immobilization, 2212 (12%) had recent surgery, and 11,647 (65%) had neither. The all-cause mortality was 10.0% (95% confidence interval [CI] 9.5-10.4), and the PE-related mortality was 2.6% (95% CI 2.4-2.9). One in every two patients who died from PE had recent immobilization (43%) or recent surgery (6.7%). Only 25% of patients with immobilization had received prophylaxis, as compared with 65% of the surgical patients. Fatal PE was more common in patients with recent immobilization (4.9%; 95% CI 4.3-5.6) than in those with surgery (1.4%; 95% CI 1.0-2.0) or those with neither (2.1%; 95% CI 1.8-2.3). On multivariate analysis, patients with immobilization were at increased risk for fatal PE (odds ratio 2.2; 95% CI 1.8-2.7), with no differences being seen between patients immobilized in hospital or in the community.
Conclusions: Forty-three per cent of patients dying from PE had recent immobilization for ≥4 days. Many of these deaths could have been prevented.
Reference:
J Thromb Haemost. 2012 Sep;10(9):1752-60. doi: 10.1111/j.1538-7836.2012.04829.x.