Guideline Development Group

Summary of Evidence

For individuals who are at risk for LE DVT, preventive measures should be initiated immediately, including education regarding leg exercises, ambulation, proper hydration, mechanical compression, and assessment regarding the need for medication referral.

Education is a key factor in risk reduction of VTE and should be provided for patients who are at elevated risk for LE DVT as well as for their families. Documentation of the patient’s understanding of these concepts should also be included.⁴² Table 5 outlines topics that should be included in this education program for patients and their families.

Immobilization is one of the primary risk factors for VTE and is a problem for patients in acute care settings, home, and long term care facilities. Table 6 provides criteria that expands the definition for immobilization as it relates to residents in long term care facilities.⁴³ Patients who are limited to a chair or bed greater than half the day during waking hours are considered at elevated risk for VTE. The acuteness and severity of the immobility determines the elevated risk-level of developing VTE.¹⁸

As immobility also occurs with long distance travel, travelers on planes for greater than 2-3 hours are also at increased risk for LE DVT. The ACCP²⁶ recommends that such travelers ambulate frequently, perform calf muscle exercises, sit in an aisle seat, and use below the knee compression stockings with at least 15-30 mm Hg compression (2C recommendation).

Action Statement 4: RECOMMEND MECHANICAL COMPRESSION AS A PREVENTIVE MEASURE FOR DVT.

Physical therapists should recommend mechanical compression (e.g. intermittent pneumatic compression &/or graded compression stockings) when individuals are at moderate to high risk of LE DVT or when anticoagulation is contraindicated. (Evidence Quality: I; Recommendation Strength: Strong)