Current Recommendations for Ambulation with patients for DVT:
Proven Benefits to Ambulation:
There is scarce literature on the timing for ambulation with patients diagnosed with a DVT. A study by Aschwanden et al, suggests that there may be an increased risk of acute PE among patients with DVT and known PE when ambulation begins early. These patients require careful consideration before beginning ambulation. The physical therapist and physician caring for a patient a with DVT must consider the following issues before deciding when a patient can safely begin ambulation:
1. Is the patient receiving adequate medical treatment for DVT (ie, LMWH or unfractionated heparin)?
2. Will ambulation place the patient at increased risk of acute PE?
3. Should a PE occur during the course of intervention, will the patient be able to tolerate this insult?
4. Will continued bed rest place the patient at increased risk of progressive DVT and at increased risk for the other complications of
bed rest?
5. Does the patient have evidence of PE before beginning ambulation?
References:
- The best evidence suggests that the incidence of new pulmonary embolism (PE), is not increased in patients with uncomplicated DVT who are mobilized early.
- Patients with DVT who are receiving appropriate anticoagulant therapy could be considered for early ambulation provided they have adequate cardiopulmonary reserve and no evidence of PE.
- Patients may safely begin ambulation once appropriate anticoagulation medication has been instituted. Meaning that patients may begin walking in the first 24 hours after they have started medical treatment.
- "Regardless of the location of the thrombi, we start treatment with therapeutic doses of LMWH and encourage mobile patients to walk as much as possible with good compression." -(Partsch H, Blattler W., 2000)
- The appropriate time to begin ambulation for the individual patient should be determined through:
- The use of compression garments have been used with ambulation in the successful trials.
Proven Benefits to Ambulation:
- Early ambulation leads to more rapid resolution of pain and swelling associated with DVT.
- Early ambulation would be particularly important for the patient with ongoing risk factors for DVT, especially patients with hypercoagulable states.
- Early ambulation is preferred in patients who have not been diagnosed with PE in the setting of DVT and who do not have cardiopulmonary.
There is scarce literature on the timing for ambulation with patients diagnosed with a DVT. A study by Aschwanden et al, suggests that there may be an increased risk of acute PE among patients with DVT and known PE when ambulation begins early. These patients require careful consideration before beginning ambulation. The physical therapist and physician caring for a patient a with DVT must consider the following issues before deciding when a patient can safely begin ambulation:
1. Is the patient receiving adequate medical treatment for DVT (ie, LMWH or unfractionated heparin)?
2. Will ambulation place the patient at increased risk of acute PE?
3. Should a PE occur during the course of intervention, will the patient be able to tolerate this insult?
4. Will continued bed rest place the patient at increased risk of progressive DVT and at increased risk for the other complications of
bed rest?
5. Does the patient have evidence of PE before beginning ambulation?
References:
- Aldrich D, Hunt DP. (2004) , When can the patient with deep venous thrombosis begin to ambulation? Physical Therapy; 84:268-273
- Hyers TM, Agnelli G, Hull RD, et al, (2001) Antithrombotic therapy for venous thromboembolic disease. (suppl 1):176S–193S
- Partsch H, Blattler W. (2000) Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. Journal of Vascular Surgery, 32:861–869