Show Notes
Should an acute lower-extremity DVT automatically stop mobility when anticoagulation is subtherapeutic? In this episode, Dr. Leo Arguelles and Dr. Nicole Neveau speak with Aubrey Little, PT, DPT, CCS, and Becky Johnson, PT, DPT, PhD, about the clinical question that grew from a quality-improvement project into a case-control study published in the Journal of Acute Care Physical Therapy.
Little and Johnson explain why a single laboratory value or protocol checkpoint cannot replace a comprehensive assessment. They discuss weighing the risks of immobility against potential adverse events while considering clot location, medical acuity, hemodynamic status, medications, laboratory trends, discharge pressures and the patient’s overall trajectory. The conversation also explores the documentation needed to make clinical reasoning visible and the value of bidirectional conversations with the interdisciplinary team.
The study included 30 patients and 60 physical therapy sessions. Its findings do not establish that mobilization at subtherapeutic anticoagulation is universally safe. The researchers emphasize the limitations of a small retrospective sample and their inability to determine whether pulmonary embolism occurred. Instead, the episode offers a thoughtful look at risk stratification, evidence-informed judgment and how clinicians can question automatic holds without abandoning patient safety.
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Today’s Guests:
Aubrey Little PT, DPT
Becky Johnson PT, DPT, PhD
https://www.linkedin.com/in/rebecca-johnson-pt-dpt-phd-619244112/
Guest Quotes:
10:07 Aubrey “ I think that’s the intention of this paper is to really think about the patient more holistically as opposed to basing clinical decision-making off of one data point or one factor.”
13:09 Aubrey “ if somebody is working in an outpatient clinic, maybe they just had a knee replacement or a hip replacement and their suspicion for an acute DVT. Does that mean that we are going to, in the moment, suggest this person is fully immobilized, call the ambulance, call the stretcher- … you cannot walk on this limb until you make it to the hospital.”
19:18 Becky “ And so when we look at the adverse events that did occur, in retrospect we’re questioning, was that an adverse event? I think if you were the clinician treating the patient, you would’ve said no. But it did meet our criteria for that.”
Rapid Responses:
Do either one of you guys know what your theme song would be if you got to have a theme song every time you walked into the room at the hospital?
Aubrey:” I would say September by Earth, Wind & Fire just ’cause that song immediately makes me dance.”
Becky: “ Maybe the songs like, Look Who’s, Guess Who’s Back Again. Eminem.
You know you’re an acute care or an ICU provider when…
Aubrey: “You ask yourself, “Is one month too short to buy a new pair of shoes for work?”
Becky: “ When you’ve got at least 8,000 steps by the time you get done with your shift.”
🎧 Connect with Our Hosts
Leo Arguelles (pronounced LEE-O R-GWELL-IS)
📧 largue2@uic.edu
🐦 Twitter: @LeoArguellesPT
Nicole Neveau, PT, DPT, NCS
📧 ngunder1@gmail.com
🔗 LinkedIn: Nicole Neveau
Danny Young, PT, DPT, PhD
📧 daniel.young@unlv.edu
🐦 X: @DLYoungDPTPhD
🌐 Bluesky: @dlyoungdptphd.bsky.social
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Show Notes