New research conducted at the VA Maryland Health Care System in collaboration with University of Maryland School of Medicine (both Baltimore, USA) finds that 100% of deep vein thrombosis (DVT) patients who combined regular aerobic exercise with anticoagulation remained free of post-thrombotic syndrome (PTS). Researchers presented these data as a late-breaking abstract at the Society for Vascular Surgery’s (SVS) Vascular Annual Meeting (VAM26; June 10–13 June, Boston, USA).
Supported by a US$1 million five-year VA Merit Grant, EFFORT-2 is a randomised controlled trial (RCT) that compares the effectiveness of standard anticoagulation versus anticoagulation combined with aerobic exercise in preventing PTS in lower-extremity DVT patients after one year.
Patients were randomly selected 1:1 to either group, and each cohort was well-matched for age, sex, body mass index, and clot states. On top of routine anticoagulation medication, the exercise group participated in 30 minutes of moderate treadmill walking three times a week for three months, to achieve at least 50% of predicted VO2 max. The primary outcome was the rate of occurrence of moderate or severe PTS (defined as a Villalta score of ≥10) at one year of follow-up.
The study enrolled 102 patients, the majority of whom were male (62%), and the cohort mean age was 53.8±13.7 years. One-year Villalta scores were available for 48 patients on anticoagulation and 45 patients prescribed anticoagulation plus exercise (93 total).
Results found that 12.5% of participants who took anticoagulation alone developed moderate or severe PTS (Villalta score ≥10), while 100% of the cohort that followed an exercise and anticoagulation regimen remained PTS-free (p=0.027). Patients who exercised showed milder symptoms on average than those on the standard anticoagulation treatment (exercise group: 2.11±2.06 standard deviation [SD] vs. anticoagulation group: 3.83±4.37 SD).
“This study shows that early regular aerobic exercise is a safe, low-risk addition to standard anticoagulation therapies that reduces post-thrombotic syndrome severity after acute DVT,” said lead author Brajesh K Lal, chief of vascular surgery at the VA Maryland Health Care System’s Baltimore VA Medical Center and professor of surgery at the University of Maryland School of Medicine.
He continued: “Since most DVT cases are diagnosed and managed by non-vascular surgeons, our findings are especially important for physicians and nurse practitioners who may have less familiarity with treating the condition. We can now see the value of exercise as not only a preventative strategy, but also a therapeutic one.”
