Deep Vein Thrombosis Responding to Blood Flow Restriction of Uninvolved Extremities: A Case Report

Abstract

BACKGROUND: Deep vein thrombosis (DVT) is a risk factor following lower extremity orthopedic surgery. Tissue plasminogen activator, a thrombus-degrading protein, is elevated after using blood flow restriction (BFR). This case study explores the use BFR concurrent with treatment of DVT. CASE PRESENTATION: A 40-year-old man presented to physical therapy (PT) 50 days following right knee lateral meniscectomy with severe pain at the lower aspect of the popliteal fossa into the proximal calf secondary to an active DVT. The patient took apixaban (5mg, twice daily) and aspirin (81mg, once daily) for a 3-month period to treat the DVT with no symptomatic improvement or change in the ultrasound imaging. OUTCOME AND FOLLOW-UP: The patient's visual analog scale for pain decreased from a 7/10 to a 1/10, and the venous duplex of the lower extremity was negative for DVT after 5 PT treatments using BFR in the uninvolved extremities over a 2.5-week period. DISCUSSION: Blood flow restriction applied to the uninvolved limbs in a patient with a DVT was associated with resolution of the DVT without adverse effects. BFR could facilitate fibrinolysis of a blood clot by increasing the tissue plasminogen activator systemically, but further study is needed. JOSPT Cases 2023;3(2):102–107. Epub: 13 April 2023. doi:10.2519/josptcases.2023.11071