A meta-analysis of bed rest versus early ambulation in the management of pulmonary embolism, deep vein thrombosis, or both

Background: Bed rest is often recommended as part of the management of deep vein thrombosis (DVT) and pulmonary embolism (PE), though this recommendation is not clearly evidence-based. Methods: Using the Cochrane Central Register of Controlled Trials, Medline, and Embase, this meta-analysis considered all randomized studies and prospective registries that compared the outcomes of patients with DVT, PE, or both, managed with bed rest versus early ambulation, in addition to anticoagulation. For each study, data regarding the incidence of new PE, new or progression of DVT, and death from all causes, were used to calculate relative risks (RR) and 95% confidence intervals (CI). Results: The 5 studies retained in this analysis included a total of 3048 patients. When compared to bed rest, early ambulation was not associated with a higher incidence of a new PE (RR 1.03; 95% CI 0.65-1.63; p = 0.90). Furthermore, early ambulation was associated with a trend toward a lower incidence of new PE and new or progression of DVT than bed rest (RR 0.79; 95% CI 0.55-1.14; p = 0.21) and lower incidence of new PE and overall mortality (RR 0.79; 95% CI 0.402-1.56; p = 0.50). Conclusions: Compared with bed rest, early ambulation of patients with DVT, PE or both, was not associated with a higher risk of progression of DVT, new PE or death. This meta-analysis does not support the systematic recommendation of bed rest as part of the early management of patients presenting with DVT, PE of both.