Early Mobilization for Patients with Venous Thromboembolism: A Review of Clinical Effectiveness and Guidelines

Key Message

One systematic review concluded that early ambulation (compared with bed rest) in adequately anticoagulated patients with acute deep-vein thrombosis (DVT) did not have a higher incidence of pulmonary embolism (PE), DVT progression, or increased mortality. Although these results were statistically significant, the clinical significance is unknown. The paper also concluded that patients with initial moderate or severe pain had better pain relief with ambulation than bed rest. There was a high degree of heterogeneity in the meta-analyses of the data, indicating wide variability between the studies and thus risk of bias.Two clinical guidelines promote early ambulation over bed rest in stable DVT patients who are anticoagulated. One guideline had a low level of evidence and a weak recommendation for ambulation over best rest, as it was based on two meta-analyses of four studies. The other guideline had a strong recommendation based on high quality evidence for physical therapy-initiated mobilization in lower-extremity DVT patients once they are therapeutically anticoagulated. This guideline identified lower quality evidence for mobilization after inferior vena cava filter placement, and provided this best practice statement based on expert opinion.