I’ve worked in various settings where it’s difficulty to know when to ambulate patients after a Pulmonary Embolism (PE)or Deep Vein Thrombosis (DVT).
Each hospital tends to have its unique protocol or approach to this matter, often neglecting the existing research on the subject.
In short, yes PT and OT should ambulate patients after a diagnosis of a DVT or PE, but you should always first check to see if the patient is stable, anticoagulated, and cleared by the physician for therapy.
Should patients with DVT or PE be on Bedrest?
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) are serious medical conditions that require careful management. Traditionally, there has been caution regarding early ambulation and physical therapy for patients diagnosed with DVT or PE.
Can a DVT become a PE after ambulation?
“No, compared with bed rest for at least 3 days, early ambulation within 3 days of diagnosis of deep ve- nous thrombosis (DVT) does not increase the risk of pulmonary embolism (PE) or the combined outcome of new PE, progression of DVT, or death related to DVT.” (Evidence-based practice)
Benefits of Early Ambulation
Contrary to previous beliefs, early ambulation in patients with DVT, PE, or both has been shown to be safe and even beneficial.
Research indicates that initiating mobility early in the course of treatment is not associated with a higher risk of DVT or PE progression or death.
Furthermore, starting mobility in anticoagulated patients has not shown an increased risk of developing a PE or a new DVT. In fact, compared to bedrest, early exercise has been linked to decreased limb pain, improved vein recanalization, and an overall enhancement in the quality of life for these patients.
Moreover, for patients with DVT on anticoagulation therapy, Active Range of Motion (AROM) or Passive Range of Motion (PROM) exercises for non-affected limbs have been found to be safe, with no increased morbidity or mortality reported.
Initiating Physical Therapy After Anticoagulation
Research suggests that early ambulation and physical therapy should be integrated into the patient’s care plan once anticoagulation is initiated.
For patients with PE, physical therapy can be initiated once the patient is deemed medically stable. This stability is characterized by stable oxygen saturation, heart rate, absence of BiPap for oxygen needs, and the absence of a large saddle embolus.
It is crucial to note that therapy should not be initiated if the patient’s cardio-respiratory status is compromised or unstable. Additionally, medical clearance or an order from the treating physician is required to commence physical therapy or occupational therapy.
Furthermore, the inclusion of gradient compression therapy for patients with lower extremity DVT appears to improve outcomes, reducing limb pain, and preventing the development of post-thrombotic syndrome (PTS).
Post-Thrombotic Syndrome (PTS) and Time Duration for Initiating Therapy
Unfortunately, there is no consensus on the optimal time duration for initiating physical therapy, occupational therapy, or therapeutic exercises after the initiation of anticoagulants.
Some physicians suggest waiting four hours after Lovenox or Heparin, while others recommend waiting 24 hours after starting Coumadin. It is imperative to confirm with the ordering physician the appropriate time to initiate PT or OT for a patient with PE or DVT once anticoagulation has commenced. Anticoagulation may be continued for three months or longer, depending on the patient’s condition.
Can you take blood pressure with an upper extremity DVT
If a patient has a DVT in the upper extremity or in the proximal neck, caution should be exercised when taking blood pressure on that arm. Reading the Doppler report and being familiar with the location of the discovered DVT is crucial to ensure proper care and avoid complications.
In conclusion, recent evidence supports the early initiation of ambulation and physical therapy for patients diagnosed with DVT or PE.
These practices have been associated with improved outcomes, decreased limb pain, and an overall enhancement in the quality of life. However, it is essential to consider individual patient factors, medical stability, and the specific recommendations of the treating physician when implementing these interventions.
Always seek medical clearance and adhere to professional guidelines to ensure the safety and well-being of patients diagnosed with DVT or PE.
Consider subscribing for more health related advice for PT and OT.
David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.