DVT & PE: How early can I mobilize a patient ??Hatoun
Formation of a blood clot in a deep veins as complication of
immobility that may contribute to Morbidity & mortality
Signs and symptoms:-Pain
-Increased warmth & Redness
- Erythema Or Bluish skin discoloration
In Fact,Over 50% of DVTs without Signs & symptoms
Pulmonary embolism (PE): Blockage of the main artery of the lung
or one of its branches by a substance that has travelled from
elsewhere in the body through the bloodstream (Usually DVT)
Signs and symptoms: - Shortness of breath ( suddenly, even at
rest) - Chest pain ( worse with deep breathe, cough, or bend) -
Other signs and symptoms may include: - Wheezing - Excessive
sweating - Arrhythmia - Weak pulse - Fainting
-PE are reported as many as one third of patients with DVT
-Most pulmonary emboli are multiple, and the lower lobes are
involved more commonly than the upper lobes
Lung with PE
900,000 PEs/ DVTs in USA in 2002
10-40% in medical or general surgery patients40-60% following
major orthopedic surgery10% hospital deaths attributed to PE
*Heit J. ASH Abstract 2005.
Age (over 40)A past history of DVTA family
historyImmobilityRecent surgery or an injury (especially hips or
Obesity PregnancyCancer and its treatments Contraceptive pill
that contains estrogen Hormone replacement therapy (HRT)Circulation
or heart problems
Methods of ProphylaxisMechanical
Early ambulationElastic stockingsIntermittent pneumatic
Pharmocologic MethodsWarfarin.Unfractionated Heparin.Low
Molecular Weight Heparin.
When Can the Patient With DVT Begin to Ambulate?
Medical Approach for Mobilizing pts with a DVT has dramatically
changed over the past several years
Partsch and Blattler (2000)
New PE development was similar in a mobile group with graduated
compression stockings and a bed rest group. They also found
decreased pain and leg edema in the mobile group.
Aschwanden et al (2001)
New PE occurred in 10 % of mobile subjects while new PE occurred
in 14 % of immobile subjects.
2 PEs occurrences in a sample of 105 patients on bedrest and 3
PEs in a sample of 114 patients who received early ambulation.
Compression and walking compared with bed rest in the treatment
of proximal DVT during pregnancy 2009
Group A:15 patients with elastic compression bandages and early
Group B: 17 patients with compression bandages and bed rest.
All patients received heparin therapy.
Subjective Pain was assessed daily with a (VAS)
Objective pain using Lowenberg test. Reduction of edema was
recorded initially and on day 2, 4 and 7.
Ultrasound was repeated after 7 days.
RESULTS: Resolution of subjective pain was faster in group A
Objective pain& measurement of leg reduced in group A
There was no pulmonary embolism and progression of thrombus
A meta-analysis of bed rest vs early ambulation in the
management of pulmonary embolism, DVT or both
2009 Sep Department of Cardiology, Cochin Hospital, AP-HP, Ren
Descartes Paris V University, Paris, France
- Considered all randomized studies and prospective registries
that compared the outcomes of patients with DVT, PE, or both,
managed with bed rest versus early ambulation, in addition to
-For each study, data regarding the incidence of new PE, new or
progression of DVT, and death from all causes, were used to
calculate relative risks (RR) and 95% confidence intervals
The 5 studies retained in this analysis included a total of 3048
patients. When compared to bed rest, early ambulation was not
associated with a higher incidence of a new PE (RR 1.03; 95% ).
Furthermore, early ambulation was associated with a trend toward
a lower incidence of new PE and new or progression of DVT than bed
rest (RR 0.79; 95% ) and overall mortality (RR 0.79; 95% ).
It appears that these studies support that early ambulation and
mobilization does not increase the risk of PE compared to bedrest
and in some cases may result in actual improvement of other factors
like pain and edema.