In the past two consecutive days, dr. Zhang Qiang's team of doctors has received consultation requests from a number of rehabilitation hospitals in Shanghai, all of which are about deep Venous Thrombosis (DVT) cases of lower extremity.
DVT may be clinically asymptomatic, but most patients present with swelling, pain, or darkening of the lower extremities. Because DVT has a certain risk of pulmonary embolism or even sudden death, it is very important to prevent and diagnose DVT early.
Most of the domestic rehabilitation hospitals accept postoperative patients from neurology, oncology and orthopedics. Patients in these specialties are precisely the high incidence of deep vein thrombosis in the lower extremities. Unlike ordinary DVT patients, such patients tend to have complex conditions and many associated diseases. Most physiotherapists face such risks and are stretched thin with their knowledge and experience.
Deep vein thrombosis can lead to pulmonary embolism
In 2015, the American Physiotherapy Association (APTA) developed clinical practice guidelines for deep vein thrombosis of the lower extremities to help physiotherapists make the right decisions when treating patients at risk for DVT. At the same time, it improves the diagnosis and management of patients with acute DVT and reduces the long-term complications of DVT, such as venous thrombosis sequelae (PTS).
The guidelines contain 14 key statements of action that apply to adult patients in all specialties (but not pregnant women or children). Physical therapists understand and master these 14 statements to avoid mistakes and errors on DVT-related issues.
1. Patients should be encouraged to move their lower limbs more to prevent venous thrombosis, unless the patient has contraindications to activity.
(Quality of evidence: I; recommended intensity: A)
2. During the initial conversation with the patient and the physical examination, the risk of DVT is assessed.
3. Provide preventive measures for high-risk patients with DVT, which should include relevant health education.
4. When the individual is at high risk for DVT, the physical therapist should recommend mechanical compression (e.g., IPC, GCS).
5. When the patient has lower limb pain, tenderness, swelling, fever or discoloration, the possibility of DVT should be considered.
(Quality of evidence: II; recommended intensity: B)
6. After completing the Wells standard evaluation of DVT, further examination is done to confirm the diagnosis, and then consider whether to encourage the patient to move.
7. For patients with acute DVT, it should be verified whether the patient is taking anticoagulant drugs, the type of anticoagulant drugs, and when to start using anticoagulants.
(Quality of evidence: V; recommended intensity: D)
8. Patients with acute new-onset DVT should start activities when the anticoagulant drug is up to standard.
9. When the patient has DVT, the physical therapist should recommend mechanical compression (e.g., IPC, GCS).
10. It is recommended that patients carry out activities after hemodynamic stabilization and after placing IVC filters.
(Quality of evidence: V;)
11. Patients with intermuscular vein thrombosis who have not received anticoagulation therapy and do not have IVC filters should consult a professional team of doctors for advice on whether they can move.
12. When the patient is during anticoagulation, the risk of falling should be assessed.
(Quality of evidence: poor; recommended intensity: C)
13. When the patient has signs and symptoms of PTS, the physiotherapist should recommend mechanical compression (e.g., intermittent inflatable compression, graded compression stockings).
(Quality of evidence: I; recommended intensity: A),
14. Patients who may have complications of DVT (e.g., severity of PTS) should be followed up and preventive strategies should be provided to improve quality of life.
Dr. Zhu Xiaoyin is in consultation
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