Introduction
Also known as blood thinners, anticoagulants are the recommended approach in the treatment of Deep Venous Thrombosis (DVT). In post-op DVTs, however, debate has arisen over the effectiveness of early ambulation in comparison to bed rest. Bed rest, often recommended in a hospital setting with the attention of healthcare personnel, has been the foundation of most post-op recovery programs. On the other hand, however, emerging research has proposed early ambulation as an effective component of post-op DVT on the basis that light activity fast-tracks the process of recovery. The current trend is that physicians should opt for early ambulation rather than bed rest as the mainstay of post-op DVT to not only lessen the time for recovery, but avert other health complications.
Post-Op Care Among DVT Patients
Recent research work has reinforced the idea that movement after DVT operation is a fundamental process that increases the chance of a speedy recovery. In a cohort study conducted among 124 patients under immobilization therapy after surgery, it was revealed that patients had an increased chance of developing recurrent DVT due to reduced ankle dorsiflexion (Aufwerber et al., 2019). With immobilization therapy, patients experience between 2-6 fold reduced blood velocity as a result of the fixation caused by staying in a neutral position. On the contrary, movement and weight bearing recovery procedures enhance the process of recovery as the body quickly returns to the usual work prior to the surgery.
Give the risks involved with an immobilization regimen post-op for DVT patients, early ambulation has received overwhelming support from recent literature. After a series of meta-analyses for different cohort studies and randomized controlled trials where the occurrence of DVT-related deaths and new pulmonary embolism were studied, the American College of Chest Physicians recommended that early ambulation should be prioritized over bed rest for all antithrombotic therapy models (Attia & Trecartin, 2018).. In another systematic review that focused on observational studies and randomized control trials spanning more than 69 years, patient ambulation was the recommended clinical practice guideline as immobility was a main risk factor for venous thromboembolism (Lau et al., 2020). Evidently, post-op DVT patients could prevent recurrent DVT by opting to start moving immediately after their surgery.
Bed rest has further been discouraged for use as a method of post-op recovery among DVT patients for an array of reasons. More specifically, Gong et al. (2020) conducted a qualitative research study in China for post-op DVT and reported that bed rest reduced the quality of life (QOL) among patients with acute DVT with multiple reports of swelling, limb numbness, fatigue, stiffness, and skin redness being common symptoms. The study further revealed that bed rest significantly affected the sleep pattern and functionality of patients as a consequence of the strict limitation of activity. Furthermore, bed rest also led to functional limitations with patients being restricted to defecating and urinating on their bed’s as they followed doctor’s instructions. The other popular subtheme reported by Gong et al. (2020) is that bed rest imposed serious psychological effects on the patients and these range from the fear of uncertainty and progression of illness, reduced self-esteem, anxiety, guilt, and self-accusation. While bed rest ensured that patients were close to their doctors, it was not a procedure that improved their wellness and it significantly compromised their ability to make a quick recovery.
Subsequent studies have also backed up Gong et al. (2020) and have demonstrated that bed rest should be avoided in post-op DVT recovery. According to Chatsis & Visintini (2018), Virchow’s triad theory postulated that the main pathogenesis resulting from DVT is the alteration of blood flow, also known as stasis. However, other factors such as inherited or acquired hypercoagulability, tampering with blood constituents, and an injury to the vascular endothelium are also potential ris factors for VTE. The fundamental concept when treating VTE is to prioritize anticoagulation, yet bed rest acts counterproductively to this approach by slowing down blood flow. Furthermore, Chatsis & Visintini (2018) stated that bed rest was historically prescribed for post-op DVT recovery as it made it easier for physicians to administer unfractionated heparin infusions, but increased chances of occurrence of secondary complications such as atrophy and muscle weakness. In essence, bed rest was only good for administering medication but not a recommended option when the main objective in post-op for any surgery is a quick return to normalcy.
In another randomized control study, patients who were recovering from incidental durotomy after lumbar spine surgery demonstrated that bed rest left damaging consequences. Prolonged bed rest did not only lower the self-esteem of the patients, it also increased cases of persistent cerebro-spinal fluid (CSF) leakage (Farshad et al., 2019).. Furthermore, patients’ prolonged bed rest meant that some patients had to undergo revision surgery and endure other symptoms such as persistent headaches. Eventually, Farshad et al.’s study recommended that patients should not miss a chance of early ambulation as it prevents them from a lot of inconveniences that may arise from bed rest. Like any other part of the body, bed rest is said to have direct negative impact on both muscles and bones. Bed rest reduces muscle strength by at least 20 to 30 percent. Evidence of muscle atrophy is witnessed with increasing cases of weakness, imbalance, and poor coordination. In terms of bones, bed rest reduces the chances of performing their weight bearing functions and this makes them weaker. Ultimately, patients who have been restricted to bed rest will not only have weakened muscles, but also increase chances of bone breakage (Chatsis & Visintini, 2018). Healthcare practitioners’ abidance to clinical evidence-base practice should encourage them to include some form of movement in a post-op recovery regime to prevent complications associated with bed rest.
Prolonged bed rest has also been discouraged not just for post-op DVT, but for many other processes that require extensive postoperative care. For instance, in a study conducted by Chen et al. (2020), where 502 patients above the age of 65 had been hospitalized after hip fracture surgery, the proportion of patients who reported complications from prolonged bed rst were more than those who opted for mobility. More specifically, 19.52% reported at least one major complication ranging from acute cerebral infarction, pulmonary infections, DVT in the lower limbs, urinary tract infections, and pressure injury (Chen et al., 2020). For the elderly person, suffering from such complications, especially DVT, significantly raises their risk for secondary health issues and may cause a prolonged road to recovery.
The process of discouraging bed rest and opting for mobility exercise is testament to the years of research that have shown the benefits of physical rehabilitation. During World War II, bed rest was highly favored as it reduced the metabolic demands placed on the body by movement and allowed healing to take its natural course. However, human spaceflight researchers compared patients under bed rest and those under physical rehabilitation in the 1960s and revealed that the former was just a precursor for deleterious events within the immune, hematologic, nervous, musculoskeletal, renal, endocrine, and cardiopulmonary systems (Thomovsky, 2021). Subsequently, the medical profession shifted from recommending bed rest for veterans recovering from different ailments such as spinal cord injury. Recent research work has further emphasized this position with clinical data from ambulation teams dealing with patients after surgery revealing that physical movement three times a day considerably reduced hospital length of stay (Stethen et al., 2018). In essence, patient recovery from any surgical procedure should maximize mobility as much as possible.
Conclusion
In conclusion, post-op care among DVT patients is a delicate procedure. Health practitioners should work with their patients and consult with the latest evidence-based literature when formulating a post-op care plan. Overwhelmingly, early ambulation is considered the best method of recuperation among patients as it sets them up for an easier path to recovery. Unlike immobilization therapy such as bed rest, early ambulation shortens the time required for hospitalization and reduces the associated risks of stasis by encouraging rapid and continuous blood flow. The growing body of research on bed rest has been linked with malignant thrombosis and unfractionated heparin infusion which further exacerbate a patient’s stay in hospital and complicate their healing process. However, some clinical trials have also suggested that the difference between the risks and benefits of using either bed rest of early ambulation are negligible and clinicians are free to choose what works well for their patients. It is worth noting that caution should be exercised to ensure keep away malignant DVT.
References
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Chen, J., Wang, X., Qian, H., Ye, J., Qian, J., & Hua, J. (2020). Correlation between common postoperative complications of prolonged bed rest and quality of life in hospitalized elderly hip fracture patients. Annals of Palliative Medicine, 9(3), 1125-1133. Web.
Farshad, M., Aichmair, A., Wanivenhaus, F., Betz, M., Spirig, J., & Bauer, D. E. (2019). No benefit of early versus late ambulation after incidental durotomy in lumbar spine surgery: A randomized controlled trial. European Spine Journal, 29(1), 141-146. Web.
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Stethen, T. W., Ghazi, Y. A., Heidel, R. E., Daley, B. J., Barnes, L., Patterson, D., & McLoughlin, J. M. (2018). Walking to recovery: The effects of missed ambulation events on postsurgical recovery after bowel resection. Journal of Gastrointestinal Oncology, 9(5), 953-961. Web.
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