Guideline Development Group

Summary of Evidence

Patients who have a documented LE DVT and have reached therapeutic levels of the prescribed anticoagulant should be mobilized out of bed and ambulate to prevent venous stasis. In doing so, deconditioning is minimized, length of hospital stay may be shortened, and other adverse effects of prolonged bed rest (e.g. decubiti) can be avoided. A common concern for mobilizing a patient with a LE DVT is that the clot will dislodge and embolize to the lungs causing a potentially fatal PE. However, early ambulation has been shown to lead to no greater risk of LE DVT than bed rest for those with a diagnosed LE DVT who have been treated with anticoagulants.²⁷

A meta -analysis found the absence of a higher risk of new PE or other adverse clinical events when individuals were ambulated instead of kept on bed rest.²⁷ The studies included in this meta-analysis had differences in the timing of ambulation following initiation of anticoagulation. Nevertheless, the conclusion arrived at was that “early” ambulation was possible as soon as the level of effective anticoagulation had been reached.²⁷ In two earlier systematic reviews, one with three studies totaling 300 patients (REF 90) and one with 9 studies (ref 22) similar conclusions were reported. A potentially reduced risk for extension of a proximal LE DVT and reduced long term symptoms of PTS with early mobility was reported, demonstrating the benefits of early mobilization of patients having LE DVT.²⁸

In 2012, the ACCP published guidelines on antithrombotic therapy and prevention of thrombosis provided a moderate strength recommendation that patients with an acute LE DVT should receive early ambulation over initial bed rest because of the potential to decrease PTS and improve quality of life.²⁶

In summary, early mobilization of anti-coagulated patients with a LE DVT does not put the patient at increased risk of PE. In fact, early mobilization has added benefits. The GDG recommends mobilizing patients with a LE DVT once anticoagulation is initiated and therapeutic levels have been achieved. Based upon the evidence that exists on time to peak therapeutic levels of the anticoagulants (Refer to Table 9), expert consensus exists to recommend early ambulation of individuals with LE DVT who are receiving anticoagulation and have reached their peak therapeutic levels based upon the specific anticoagulation medication they are prescribed.