When Can the Patient With Deep Venous Thrombosis Begin to Ambulate?

Deep venous thrombosis (DVT) is a common problem among hospitalized patients,1 even those who receive prophylaxis.2 Patients undergoing total hip replacement have a 54% risk of developing DVT following the procedure if no methods of prophylaxis are used.2 Use of low-molecular-weight heparin prophylaxis reduces this incidence to 16%. Despite prophylaxis, 31% of patients undergoing total knee replacement develop DVT, and 27% of patients operated on for hip fracture develop DVT.2 Thromboembolic complications have been reported in 30% to 60% of patients following stroke.3 Deep venous thrombosis places the patient at risk for pulmonary embolism (PE), recurrent thrombosis, and post-phlebitic syndrome.1,4 Up to 50% of patients with DVT involving the proximal deep veins of the lower extremity develop PE. Because the mortality rate for this condition is as high as 8% even with intervention, PE poses the greatest concern to the physical therapist and physician caring for the patient during initial management of the DVT, particularly in the hospital setting.3 Current medical management of patients with DVT includes the use of acute anticoagulation with heparin or low-molecular-weight heparin (LMWH) followed by long-term intervention with warfarin.5 The use of full-dose heparin has been shown to reduce the incidence of PE among patients with proximal DVT.4 Low-molecular-weight heparin demonstrated at least equal efficacy to heparin in multiple trials.6 In the past, patients with active DVT were placed on bed rest for periods up to 7 to 10 days due to the fear of PE among patients who remain active.7 The logical, if simplistic, argument was that vigorous movement of the involved limb would cause the proximal clot to “break off and travel to the lungs.” More recent practice has included earlier ambulation, but there has been reluctance to begin ambulation …