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Applying Clinical Decision Rules in a Patient With Venous Thromboembolism After an Elective Total Knee Arthroplasty

A Case Report

Heick, John D., PT, PhD

Cardiopulmonary Physical Therapy Journal: February 15, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/CPT.0000000000000109
Case Report: PDF Only

Introduction: Venous thromboembolism (VTE) includes both deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease behind myocardial infarction and stroke, and is responsible for 10% of hospital deaths as a result of PE. The purposes of this case report are to (1) describe such an incident in a 63-year-old man status-post right total knee arthroplasty who is referred to physical therapy and (2) highlight the role of using clinical decision rules (CDRs) and the recently published VTE clinical practice guidelines.

Case presentation: A 63-year-old man presented to an orthopedic surgeon for elective total knee arthroplasty of the right knee. The patient reported for his initial physical therapy session 3 weeks after surgery, and while warming up on a recumbent bicycle, he started having difficulty catching his breath. The patient was ultimately diagnosed with bilateral PE and a right lower extremity proximal DVT.

Conclusion: This case illustrates the importance of using an evidence-based approach for determining the clinical probability of VTE by following clinical guidelines. This case also highlights the importance of using CDRs and communicating in a timely manner to ensure patient safety.

Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ

Correspondence: John D. Heick, PT, PhD, Physical Therapy and Athletic Training, Northern Arizona University, PO Box 15105, Building 66, Flagstaff, AZ 86011 (

The author declares no conflicts of interest.

© 2019 Cardiovascular and Pulmonary Section, APTA
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