Guideline Development Group

Introduction

Venous thromboembolism (VTE) is the formation of a blood clot in a deep vein that can lead to complications including deep vein thrombus (DVT), a pulmonary embolism (PE), or post thrombotic syndrome (PTS). VTE is a serious condition with an incidence of 10%-30% of people dying within one month of diagnosis and half of those diagnosed with a DVT have long term complications.¹ Even with a standard course of anticoagulant therapy, one third of individuals will experience another VTE within 10 years.¹ For those who survive a VTE, quality of life can be decreased due to the need for long term anticoagulation to prevent another VTE.²

No matter the practice setting, physical therapists work with patients who are at risk for and/or have a history of VTE. Additionally, physical therapists are routinely tasked with mobilizing patients immediately after diagnosis of a VTE. Because of the seriousness of VTE, the frequency that physical therapists encounter patients with a suspected or confirmed VTE, and the need to prevent future VTE, the American Physical Therapy Association (APTA) in conjunction with the Cardiovascular & Pulmonary and Acute Care Sections of the APTA, support the development of this clinical practice guideline (CPG). It is intended to assist all physical therapists in their decision making process when managing patients at risk for VTE or diagnosed with a lower extremity deep vein thrombosis (LE DVT).

In general, CPGs optimize the care of patients by building upon the best evidence available while at the same time examining the benefits and risks of each care option.³ The VTE guideline development group (GDG) followed a systematic process to write this CPG with the overall objective of providing physical therapists with the best evidence in preventing VTE, screening for LE DVT, mobilization of patients with LE DVT, and management of complications of LE DVT. Specifically, this CPG will:

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  Discuss the role of physical therapists in identifying patients who are high risk of a VTE and actions that can be taken to decrease the risk of a first or recurring VTE.
  
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  Provide physical therapists with specific tools to identify patients who may have a LE DVT and determine the likelihood of a LE DVT.
  
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  Assist physical therapists in determining when mobilization is safe for a patient diagnosed with a LE DVT based on the treatment chosen by the inter-professional team.
  
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  Describe interventions that will decrease diagnosis complications such as Post-Thrombotic Syndrome (PTS) or another VTE.
  
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  Create a reference publication for healthcare providers, patients, families/caretakers, educators, policy makers, and payers on the best current practice of physical therapy management of patients at risk for VTE and diagnosed with a LE DVT.
  
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  Identify areas of research that are needed to improve the evidence base for physical therapy management of patients at risk for or diagnosed with VTE.
  

This CPG can be applied to adult patients across all practice settings, but does not address nor apply to those who are pregnant or to children. Additionally, this guideline does not discuss the management of PE, upper extremity DVT (UE DVT) or chronic thromboembolism pulmonary hypertension (CTEPH). While primarily written for physical therapists, other healthcare professionals should find this CPG helpful in their management of patients who are at risk for or have a diagnosed VTE.