Action Statement 8: MOBILIZE PATIENTS WHO ARE AT A THERAPEUTIC LEVEL OF ANTICOAGULATION.
When a patient has a recently diagnosed LE DVT, physical therapists should initiate mobilization when therapeutic threshold levels of anticoagulants have been reached.
(Evidence Quality: I, Recommendation. Strength: Strong)
Benefit: Decreased risk of subsequent LE DVT or PE; decreased risk of adverse effects of bed rest.
Risk, Harm, Cost: Risks associated with use of anticoagulants include increased risk of bleeding. If an anticoagulant is not at a therapeutic level, there may be an increased risk of PE with mobilization.
Value Judgments: The evidence for mobility to prevent venous thromboembolism is strong, although the evidence on when to initiate mobility may not be as strong and is based upon the patient achieving the therapeutic level of the anticoagulant. Physical therapists should mobilize patients as soon as possible after diagnosis of venous thromboembolism as long as the risk of PE is decreased. Achieving the therapeutic level of the anticoagulant has been shown to diminish the risk of developing a PE.
Intentional Vagueness: Specific anticoagulants or their therapeutic levels are not recommended. Instead, evidence-based guidelines and algorithms have been provided for guidance. Physical therapists should work within their healthcare system to develop institution-specific protocols.
Role of Patient Preference: Patients should be aware of the anticoagulation they are prescribed and the effect that the anticoagulant will have on their lifestyle (amount of medical monitoring, risk of bleeding, foods to avoid, risk of brain bleed, etc.) In addition, patients should be informed regarding the risk of immobility in developing further VTE, and the benefit of mobility.
Exclusions: The risk of bleeding is present when anyone takes anticoagulants. However, those with HIT, a history of HIT, recent bleeding events, or increased risk of bleeding should be prescribed treatment other than anticoagulation including mechanical compression or intravenous filters.
