Venous Thromboembolism Prevention in Rehabilitation: a Review and Practice Suggestions

Abstract

Venous thromboembolism (VTE) is a frequent complication of acute hospital care, and this extends to in-patient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important VTE, associated mortality and costs of care. While there has been extensive research on optimal approaches to VTE prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of VTE and its prevention related to in-patient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of VTE after another thrombotic insult. Low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs) are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for VTE prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.