Deep Vein Thrombosis (DVT)

Definition: Also known as Thrombophlebitis

Deep vein thrombosis is a blood clot in a vein deep within the body. Deposits
of red blood cells and clotting elements in the blood can accumulate in a vein
and lead to blood clot formation. Clots usually occur in the legs but can occur
in other locations. As the clot grows, it blocks blood flow in the affected vein.

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Causes

Several factors contribute to clot formation, including:

 Slow blood flow, often due to lying or sitting still for an extended period
of time
 Pooling of blood in a vein, often due to:
o Immobility
o Medical conditions
o Damage to valves in a vein or pressure on the valves, such as
occurs during pregnancy
 Injury to a blood vessel
 Clotting problems (can occur due to aging or disease)
 Catheters placed in a vein

Risk Factors

 Not moving your body eg long aeroplane & train trips

 Hospitalization eg bed rest
 Surgery, especially involving bones or joints
 Medical conditions such as:
o Varicose veins
o Cancer
o Heart failure

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 o Heart attack
o Inflammatory bowel disease
o Blood disorders
 Obesity
 History of deep vein thrombosis
 Taking birth control pills or estrogen therapy
 Pregnancy

Symptoms

 Pain
 Swelling of a limb, possibly hard & cord-like in the swollen area
 Tenderness along the vein
 Warmth & itchiness of the skin in the inflamed area
 Redness, paleness or blueness of the skin of the affected limb
 Possible bruising

Some patients may not experience any symptoms until the clot moves to the
lungs, a condition called pulmonary embolism.

DVT Test

Homans Sign:

 Sit client on side of the table, remove any bolstering

 Extend knee so that the leg is straight, lift leg slightly

 Passively dorsiflex their ankle with some overpressure, while feeling for
heat & swelling in the calf

 If these signs are present and the action of dorsiflexion increases the
pain to the back of the knee/calf, then the test is Positive.
 If the test is positive, it is a medical emergency. Refer to a doctor
directly or arrange for transportation to a Hospital.

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Treatment

 Anticoagulant drugs to prevent additional clot formation including

heparin & warfarin and fibrinolytic enzymes to help dissolve clots.
 Compression bandages and elevation of limbs help reduce the pooling
of blood.

 Further massage should not be applied until you have clearance from
the doctor. No deep or remedial work should be performed with the
client is on anticoagulant medications, or has Post Thrombotic
Syndrome

Prevention

General prevention measures include:

 Not sitting for long periods, such as in a car or airplane or at a

computer. Get up frequently and move around, do range of motion
exercises, wear compression stockings on long flights
 Not smoking
 Doctors may advise the use of anticoagulants before long trips

What does a DVT look like?

Below are a few images of deep vein thrombosis. All images are courtesy of Charlie Goldberg, M.D. and Jan
Thompson, whose website is located at http://medicine.ucsd.edu/clinicalmed. 10/04/07

Reference:
Salvo,S.G. Massage Therapy Principles and Practice
WB Saunders Company, USA 1999