Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism
Publication Date: May 13, 2022
Last Updated: May 17, 2022
Key Action Statements
Statement
1. Advocate for a culture of mobility and physical activity in all practice settings unless medical contraindications for mobility exist. (I, A)
1. Advocate for a culture of mobility and physical activity in all practice settings unless medical contraindications for mobility exist. (I, A)
Phrase
Advocate for a culture of mobility and physical activity.
Advocate for a culture of mobility and physical activity.
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Statement
2. During initial interview and physical examination assess risk of VTE in patients with reduced mobility. (I, A)
2. During initial interview and physical examination assess risk of VTE in patients with reduced mobility. (I, A)
Phrase
Assess for risk of VTE with reduced mobility.
Assess for risk of VTE with reduced mobility.
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Statement
3. When a patient presents with conditions (i.e., cancer or inherited clotting disorder) that independently increase VTE risk, therapists should have a high index of suspicion for VTE and assess for additional risk factors. (I, B)
3. When a patient presents with conditions (i.e., cancer or inherited clotting disorder) that independently increase VTE risk, therapists should have a high index of suspicion for VTE and assess for additional risk factors. (I, B)
Phrase
Assess for additional risk factors of VTE in all high-risk patients.
Assess for additional risk factors of VTE in all high-risk patients.
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Statement
4. When a patient is identified as high risk for VTE, provide preventive measures including education on the signs and symptoms of VTE, activity, hydration, mechanical compression and referral for medical treatment. (I, A)
4. When a patient is identified as high risk for VTE, provide preventive measures including education on the signs and symptoms of VTE, activity, hydration, mechanical compression and referral for medical treatment. (I, A)
Phrase
Provide preventive measures for those who are high risk for VTE.
Provide preventive measures for those who are high risk for VTE.
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Statement
5. When a patient presents with pain, tenderness, swelling, warmth and/or discoloration in the lower extremity, establish the likelihood of a LE DVT and take appropriate action based on results. (I, A)
5. When a patient presents with pain, tenderness, swelling, warmth and/or discoloration in the lower extremity, establish the likelihood of a LE DVT and take appropriate action based on results. (I, A)
Phrase
Establish the likelihood of LE DVT when a patient presents with symptoms.
Establish the likelihood of LE DVT when a patient presents with symptoms.
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Statement
6. When a patient present with clinical symptoms including swelling, pain, edema, cyanosis and/or dilation of superficial veins, establish the likelihood of UE DVT and take appropriate action based on results. (I, B)
6. When a patient present with clinical symptoms including swelling, pain, edema, cyanosis and/or dilation of superficial veins, establish the likelihood of UE DVT and take appropriate action based on results. (I, B)
Phrase
Establish the likelihood of UE DVT when patient presents with symptoms.
Establish the likelihood of UE DVT when patient presents with symptoms.
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Statement
7. When a patient presents with dyspnea, chest pain, presyncope or syncope, and/or hemoptysis, evaluate the likelihood of PE and take appropriate action based on results. (I, A)
7. When a patient presents with dyspnea, chest pain, presyncope or syncope, and/or hemoptysis, evaluate the likelihood of PE and take appropriate action based on results. (I, A)
Phrase
Establish the likelihood of PE when a patient presents with symptoms.
Establish the likelihood of PE when a patient presents with symptoms.
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Statement
8. When a patient presents with a recently diagnosed provoked or unprovoked VTE, assess medical intervention. (V, P)
8. When a patient presents with a recently diagnosed provoked or unprovoked VTE, assess medical intervention. (V, P)
Phrase
Assess medical intervention.
Assess medical intervention.
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Statement
9. With a recently diagnosed VTE treated pharmacologically, confirm medication class and date/time initiated prior to mobilizing patient. (V, P)
9. With a recently diagnosed VTE treated pharmacologically, confirm medication class and date/time initiated prior to mobilizing patient. (V, P)
Phrase
Confirm pharmacological intervention and time initiated.
Confirm pharmacological intervention and time initiated.
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Statement
10. When a patient with a recently diagnosed lower extremity DVT reaches therapeutic threshold of anticoagulant medication, mobilize the patient. (I, A)
10. When a patient with a recently diagnosed lower extremity DVT reaches therapeutic threshold of anticoagulant medication, mobilize the patient. (I, A)
Phrase
Mobilize patients with LE DVT when therapeutic level of anticoagulation is achieved.
Mobilize patients with LE DVT when therapeutic level of anticoagulation is achieved.
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Statement
11. When a patient with a recently diagnosed upper extremity DVT reaches the therapeutic threshold of anticoagulant medication, upper extremity activities can begin. (V, R)
11. When a patient with a recently diagnosed upper extremity DVT reaches the therapeutic threshold of anticoagulant medication, upper extremity activities can begin. (V, R)
Phrase
Mobilize patients with UE DVT when therapeutic level of anticoagulation is achieved.
Mobilize patients with UE DVT when therapeutic level of anticoagulation is achieved.
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Statement
12. When a patient has a newly diagnosed LE DVT, do not routinely recommend mechanical compression (e.g. intermittent pneumatic compression &/or graduate compression stockings). (II, B)
12. When a patient has a newly diagnosed LE DVT, do not routinely recommend mechanical compression (e.g. intermittent pneumatic compression &/or graduate compression stockings). (II, B)
Phrase
Do not routinely recommend mechanical compression for those with a new DVT.
Do not routinely recommend mechanical compression for those with a new DVT.
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Statement
13. When a patient has an inferior vena cava (IVC) filter for LE DVT implanted, mobilize the patient once they are hemodynamically stable and there is no bleeding at the puncture site. (V, P)
13. When a patient has an inferior vena cava (IVC) filter for LE DVT implanted, mobilize the patient once they are hemodynamically stable and there is no bleeding at the puncture site. (V, P)
Phrase
Mobilize individuals with an IVC filter.
Mobilize individuals with an IVC filter.
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Statement
14. When a patient presents with a documented LE DVT below the knee, is not anticoagulated, does not have an IVC filter and patient is prescribed out of bed mobility by the physician, consult with the medical team. (V, P)
14. When a patient presents with a documented LE DVT below the knee, is not anticoagulated, does not have an IVC filter and patient is prescribed out of bed mobility by the physician, consult with the medical team. (V, P)
Phrase
Consult the medical team to initiate mobility with a patient with distal LE DVT not treated with IVC filter or anticoagulant.
Consult the medical team to initiate mobility with a patient with distal LE DVT not treated with IVC filter or anticoagulant.
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Statement
15. When a patient with a non-massive, low-risk PE achieves the therapeutic threshold of anticoagulant medication, physical therapists may mobilize the patient. (I, A)
15. When a patient with a non-massive, low-risk PE achieves the therapeutic threshold of anticoagulant medication, physical therapists may mobilize the patient. (I, A)
Phrase
Mobilize patient with non-massive (low risk) PE when therapeutic level of anticoagulation is achieved.
Mobilize patient with non-massive (low risk) PE when therapeutic level of anticoagulation is achieved.
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Statement
16. When a patient presents with a massive or submassive PE categorized as high or intermediate risk, do not mobilize patient until criteria are met for low-risk PE and the patient is hemodynamically stable. (V, P)
16. When a patient presents with a massive or submassive PE categorized as high or intermediate risk, do not mobilize patient until criteria are met for low-risk PE and the patient is hemodynamically stable. (V, P)
Phrase
Do not mobilize massive PE or submassive/intermediate high-risk PE until low risk and hemodynamically stable.
Do not mobilize massive PE or submassive/intermediate high-risk PE until low risk and hemodynamically stable.
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Statement
17. When a patient with a documented VTE does not show improvement in signs/symptoms of VTE after one to two weeks of medical treatment (anticoagulation, IVC filter, catheter or surgical intervention), refer the patient for medical re-evaluation. (V, P)
17. When a patient with a documented VTE does not show improvement in signs/symptoms of VTE after one to two weeks of medical treatment (anticoagulation, IVC filter, catheter or surgical intervention), refer the patient for medical re-evaluation. (V, P)
Phrase
Refer patient for medical re-evaluation if no improvement in signs and symptoms of VTE after one to two weeks.
Refer patient for medical re-evaluation if no improvement in signs and symptoms of VTE after one to two weeks.
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Statement
18. When a patient presents with long-term consequences of VTE (post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension or history of VTE), consider referring patients for management strategies to minimize secondary long-term complications of VTE to improve function or quality of life and to prevent recurrent VTE. (V, P)
18. When a patient presents with long-term consequences of VTE (post-thrombotic syndrome, chronic thromboembolic pulmonary hypertension or history of VTE), consider referring patients for management strategies to minimize secondary long-term complications of VTE to improve function or quality of life and to prevent recurrent VTE. (V, P)
Phrase
Refer patient for medical management of the long-term consequences of VTE.
Refer patient for medical management of the long-term consequences of VTE.
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Statement
19. When a patient presents with signs and symptoms consistent with post-thrombotic syndrome (PTS), recommend mechanical compression (e.g. intermittent pneumatic compression &/or graduated compression stockings). (I, B)
19. When a patient presents with signs and symptoms consistent with post-thrombotic syndrome (PTS), recommend mechanical compression (e.g. intermittent pneumatic compression &/or graduated compression stockings). (I, B)
Phrase
Recommend mechanical compression when signs and symptoms of PTS are present.
Recommend mechanical compression when signs and symptoms of PTS are present.
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Recommendation Grading
Overview
Title
Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism
Authoring Organization
American Physical Therapy Association
Publication Month/Year
May 13, 2022
Last Updated Month/Year
February 6, 2024
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
Describe evidence-based practice, including diagnosis, prognosis, intervention, and assessments of outcomes for musculoskeletal disorders. Classify and define common musculoskeletal conditions using the World Health Organization's terminology related to impairments of body function and body structure, activity limitations, and participation restrictions. Identify interventions supported by current best evidence to address impairments of body function and structure, activity limitations, and participation restrictions associated with common musculoskeletal conditions. Identify appropriate outcome measures to assess changes resulting from physical therapy interventions in body function and structure as well as in activity and participation of the individual. Provide a description to policy makers, using internationally accepted terminology, of the practice of orthopaedic physical therapists and hand rehabilitation. Provide information for payers and claims reviewers regarding the practice of orthopaedic and hand therapy for common musculoskeletal conditions. Create a reference publication for clinicians, academic instructors, clinical instructors, students, interns, residents, and fellows regarding the best current practice of orthopaedic physical therapy and hand rehabilitation
Inclusion Criteria
Male, Female, Adult, Older adult
Health Care Settings
Ambulatory, Emergency care, Outpatient, Operating and recovery room
Intended Users
Nurse, nurse practitioner, physical therapist, physician, physician assistant
Scope
Assessment and screening, Management, Prevention, Rehabilitation
Diseases/Conditions (MeSH)
D054556 - Venous Thromboembolism, D020246 - Venous Thrombosis
Keywords
Venous Thromboembolism, management of venous thromboembolism, DVT
Source Citation
Ellen Hillegass, PT, EdD, CCS FAPTA, Kathleen Lukaszewicz, PT, PhD, Michael Puthoff, PT, PhD, for the Guideline Development Group, Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed with Venous Thromboembolism: Evidence-Based Clinical Practice Guideline 2022, Physical Therapy, 2022;, pzac057, https://doi.org/10.1093/ptj/pzac057
Methodology
Number of Source Documents
139
Literature Search Start Date
May 1, 2003
Literature Search End Date
May 1, 2014