Sasima Tongsai1, Visanu Thamlikitkul. 1. Clinical Epidemiology Unit, Office for Research and Development, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
OBJECTIVE: Early ambulation after percutaneous coronary intervention (PCI) could increase patient comfort, decrease length of hospital stay, and reduce the costs. However, this approach may increase the risk of vascular complications and has not been well assessed. This study was conducted to assess the safety of early ambulation versus late ambulation by combining the study results on safety in patients undergoing PCI. MATERIALS AND METHODS: Studies were identified via five electronic databases, hand search and grey literature databases up to December 2011. We performed a meta-analysis of five randomized controlled trials to compare the safety of early versus late ambulation in the treatment of cardiac patients undergoing PCI. Of 1854 patients, 1083 were assigned to an early ambulation (range: 2-4 h of bed rest time) and 771 were assigned to late ambulation (range: 6-10 h of bed rest time). RESULTS: There was no evidence that early ambulation was more harmful than late ambulation in terms of haematoma or bleeding event. The pooled relative risk (RR) of haematoma was 0.82 (95% CI, 0.53-1.28) and bleeding, 1.77 (95% CI, 0.87-3.59). A funnel plot showed minimal evidence of publication bias for haematoma event. CONCLUSIONS: The results of this first meta-analysis indicated that early ambulation after PCI was not associated with an increased risk of haematoma or bleeding. This study also confirmed the findings of the included studies recommending reducing the bed rest time from 6-10 h to 2-4 h after removal of the arterial sheath, and supporting early mobilization.
OBJECTIVE: Early ambulation after percutaneous coronary intervention (PCI) could increase patient comfort, decrease length of hospital stay, and reduce the costs. However, this approach may increase the risk of vascular complications and has not been well assessed. This study was conducted to assess the safety of early ambulation versus late ambulation by combining the study results on safety in patients undergoing PCI. MATERIALS AND METHODS: Studies were identified via five electronic databases, hand search and grey literature databases up to December 2011. We performed a meta-analysis of five randomized controlled trials to compare the safety of early versus late ambulation in the treatment of cardiacpatients undergoing PCI. Of 1854 patients, 1083 were assigned to an early ambulation (range: 2-4 h of bed rest time) and 771 were assigned to late ambulation (range: 6-10 h of bed rest time). RESULTS: There was no evidence that early ambulation was more harmful than late ambulation in terms of haematoma or bleeding event. The pooled relative risk (RR) of haematoma was 0.82 (95% CI, 0.53-1.28) and bleeding, 1.77 (95% CI, 0.87-3.59). A funnel plot showed minimal evidence of publication bias for haematoma event. CONCLUSIONS: The results of this first meta-analysis indicated that early ambulation after PCI was not associated with an increased risk of haematoma or bleeding. This study also confirmed the findings of the included studies recommending reducing the bed rest time from 6-10 h to 2-4 h after removal of the arterial sheath, and supporting early mobilization.