Physical Therapy Management in Patients with Venous Thromboembolism

Question 1

Indications for Anticoagulation

Answer 1

Deep Vein Thrombosis (DVT)
Pulmonary Embolism (PE)
Atrial Fibrillation (AFib)
Stroke Prevention
Post-Surgical Prophylaxis
Signs of clot: swelling, tenderness, erythema, SOB for PE
Most reliable test: Ultrasound

Question 2

Wells Criteria

Answer 2

• active cancer
• immobility >3 days OR major surgery <4 weeks
• calf swelling >3cm
• collateral (nonvaricose) superficial veins
• entire leg is swollen
• localized tenderness along deep venous system
• pitting edema, greater in symptomatic leg
• paralysis, paresis, or recent plaster immobilization of LE
• previously documented DVT
• alternate diagnosis to DVT as likely or more likely (-2)

Question 3

Wells Criteria scoring

Answer 3

2-0 = low risk

1-2 = mod risk

> 3 = high risk

Question 4

Homan Sign

Answer 4

Forcing patients foot to dorsiflex with knee extended

Check for pain in calf when applying light squeeze

Poor sensitivity and specificity

Question 5

Anticoagulation Therapies

Answer 5

Heparin
Coumadin

Question 6

Heparin:

Answer 6

A fast-acting anticoagulant used for the prevention and treatment of blood clots.

Administered intravenously or subcutaneously.

Common in hospital settings for DVT/PE prophylaxis.

Enhances activity of antithrombin III, inhibiting thrombin and factor Xa.

Question 7

Coumadin (Warfarin):

Answer 7

A slower-acting oral anticoagulant.

Used for long-term prevention of thromboembolic events.

Requires regular INR (International Normalized Ratio) monitoring.

Inhibits vitamin K-dependent clotting factors (II, VII, IX, X).

Question 8

Risks of Mobilizing Patients

Answer 8

Bleeding Risk: Increased risk of spontaneous bleeding with high anticoagulation levels.

Falls: Coumadin increases risk of bleeding if the patient falls.

Post-Operative Considerations: Mobilization can improve outcomes but must be balanced against bleeding risks.

Question 9

Benefits of Mobilizing Patients

Answer 9

Prevention of DVT: Early mobility is critical in preventing venous thromboembolism (VTE).

Improved Outcomes: Mobilization decreases risk of pneumonia, enhances functional recovery.

Cardiovascular Benefits: Early mobilization improves circulation and cardiac function. revention of DVT: Early mobility is critical in preventing venous thromboembolism (VTE).

Improved Outcomes: Mobilization decreases risk of pneumonia, enhances functional recovery.

Cardiovascular Benefits: Early mobilization improves circulation and cardiac function.

Question 10

Guidelines and Best Practices For Heparin:

Answer 10

Mobilization typically safe when Activated Partial Thromboplastin Time or Anti-factor Xa Assau is within therapeutic range and measured in time since administration, and no other contraindications exist.

Question 11

Guidelines and Best Practices For Coumadin:

Answer 11

Mobilization may proceed with caution if INR is within or just above the therapeutic range.

Question 12

Red Flags

Answer 12

Signs of Bleeding: Hematuria, hematoma, epistaxis, petechiae.

New DVT/PE Symptoms: Sudden shortness of breath, chest pain, leg swelling.

High INR or aPTT: Extreme caution or delay in mobilization may be necessary.

Question 13

Clinical Decision Making Framework

Answer 13

Patient’s Medical Status: Current clot risk vs. bleeding risk. Recent surgeries or interventions.

Anticoagulation Status: Review of current aPTT or INR level and time since last dose of anticoagulant.

Functional Mobility: Patient’s baseline mobility and fall risk.

Cognitive and physical abilities.

Environment: Hospital bed vs. chair mobility. Supervision level and fall prevention strategies.