Incidence of Adverse Events When Mobilizing Patients With Acute Lower Extremity Deep Vein Thrombosis at Subtherapeutic Anticoagulation Level: A Case–Control Study

Introduction: The purpose of this study was to examine the incidence of adverse events (AE) when physical therapists mobilized hospitalized patients with acute lower extremity (LE) deep vein thrombosis (DVT) at subtherapeutic versus therapeutic anticoagulation levels. Review of Literature: The 2022 Clinical Practice Guideline supported by the American Physical Therapy Association's Academy of Cardiovascular and Pulmonary Physical Therapy and the Academy of Acute Care provides recommendations for physical therapy management of venous thromboembolism (VTE). The guideline advises initiating mobility once anticoagulation reaches a therapeutic level in patients with acute DVT. However, limited evidence exists regarding AE during mobilization, suggesting a potential gap between stated recommendations and clinical practice. The aim of this study was to describe the incidence of AE during physical therapy sessions in hospitalized patients with acute LE DVT who were at subtherapeutic anticoagulation levels. Subjects and Methods: A retrospective review of medical records from 30 hospitalized patients across 60 physical therapy sessions was conducted. Convenience sampling was used. Data included demographics, Charlson Comorbidity Index score, anticoagulation status, level of mobility during therapy, and presence of AE. Between-group differences in continuous variables were assessed using independent-samples t tests. Differences in session-level mobility distributions were evaluated using the Fisher–Freeman–Halton exact test. Results: Of the 60 sessions, 29 occurred when patients were at a therapeutic level of anticoagulation and 31 when patients were at a subtherapeutic level. No AE occurred in the therapeutic level group (0%). Three AE (9.7%) occurred in the subtherapeutic level group. There was no association between anticoagulation status and AE ( P = .238), and no patient required escalation in level of care, intubation, or rapid response activation within 12 hours of physical therapy intervention. Discussion and Conclusion: Adverse events observed during the mobilization of patients with acute LE DVT were not clearly associated with anticoagulation status alone, highlighting the importance of patient-specific clinical factors when assessing mobility risk.