The Centers for Disease Control reports that 60,000 – 100,000 Americans die annually due to deep-vein thrombosis / pulmonary embolism (PE). Sudden death is the first symptom for 25 percent of people who have a PE. Among people who have a history of a deep-vein thrombosis (DVT), one third to one half will have lifelong complications (post-thrombotic syndrome) such as swelling, pain, discoloration, and scaling in the affected limb.¹

Risk Factors

Surgery / Injury: The risk of developing DVT / PE is highest after major surgery or a major injury, or when you have heart failure, cancer or a heart attack.² Knee and hip replacement surgery, specifically, carry the highest risk for venous thromboembolism (VTE), followed by major surgeries such as peripheral and coronary artery bypass surgery, cancer removal surgery, neurosurgery and abdominal surgery.

Venous circulation slows down due to lack of movement, which increases the risk of blood clotting. The risk of VTE is highest during the first three months after a surgery.²

Pregnancy and childbirth: During the first six weeks after giving birth, women are at a higher risk for developing VTE. Surgery for cesarean delivery also increases the risk of blood clots.²

Lack of movement: Not moving for long periods (bedrest, long flights, when a cast is placed, etc.) are additional risk factors. Slow blood flow may create a low-oxygen environment that makes it easier for clot formation.²

Certain conditions: Other medical conditions which increase the risk of developing VTE include the following:²

• Spinal cord injury
• Trauma such as a broken hip or leg bone
• Cancers
• Heart conditions such as heart attack or congestive heart failure
• Stroke
• Obesity
• Varicose veins that are large and untreated
• Infections such as SARS-CoV-2
• Sickle cell disease

Age and other factors: After age 40, the risk of VTE doubles every 10 years. Family history, genetics, sex, race / ethnicity, and hormone-based medications are risk factors as well.²

Clinical Signs

Clinical manifestations of pulmonary embolism are nonspecific and occur in many disorders.³

Symptoms of PE: Chest pain; the pleuretic variety is the most common, followed by dyspnea. Apprehension or impending doom is frequently reported.

Signs of PE: Tachypnea is present in most patients with PE. Tachycardia, low-grade fever, and the presence of lower extremity swelling or tenderness are other important signs.

Prevention With Acupuncture?

Findings from acupuncture studies are promising and worth exploring at academic research hospitals. Acupuncture stimulation has been found to prevent DVT in elderly patients (60 years or older) after malignant gastrointestinal tumor surgery.⁴ Another study found improved hemorheological indices in postoperative, bedridden, elderly patients after acupuncture treatment.⁵ Specific acupuncture-point combinations accelerated lower-limb venous flow in these bedridden postsurgical patients.

Acute postoperative acupuncture requires additional educational training beyond what the master's and doctorate programs currently provide in the United States. Acupuncture may not be recommended for some patients in the acute postoperative state; an evaluation of the patient, review of medical records, review of systems, and ruling out potential contraindications of treatment are required of the acupuncture inpatient consultant (it is out of the scope of this article to address these concerns).

Acupuncture may reduce death rates due to deep-vein thrombosis / pulmonary embolism based on the research findings above. My area of practice is perioperative acupuncture; a large, multi-center, randomized, controlled trial to investigate if acupuncture may reduce postoperative DVT/PE and/or post-thrombotic syndrome is warranted to address this public health concern. However, we must educate and train acupuncturists to provide such care in the acute setting.

P.S.: I recommend patients avoid cryotherapy during the first three months after surgery. DVT is listed as a contraindication to cryotherapy, and since there may be no signs / symptoms, it is best to avoid cryotherapy during this time frame.⁶

References

1. Data and Statistics on Venous Thromboembolism. Centers for Disease Control and Prevention.
2. Venous Thromboembolism. National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.
3. Saint S, Frances C. Saint-Frances Guide to Inpatient Medicine. 2nd Edition. Lippincott Williams & Wilkins; 2004, p.p. 142-143.
4. Hou LL, Yao LW, Niu QM, et al. Preventive effect of electrical acupoint stimulation on lower-limb thrombosis: a prospective study of elderly patients after malignant gastrointestinal tumor surgery. Cancer Nurs, 2013;36(2):139-144.
5. Hou L, Chen C, Xu L, et al. Electrical stimulation of acupoint combinations against deep venous thrombosis in elderly bedridden patients after major surgery. J Tradit Chin Med, 2013;33(2):187-193.
6. Rodriguez N. "Is Cryotherapy Safe? And Other Frequently Asked Questions." Carbon World Health Blog, Sept. 8, 2017.

Dr. Shabnam Pourhassani attained a bachelor's degree in holistic science (2006) and master's degree in acupuncture and Oriental medicine (2008) from South Baylo University; and her doctorate in acupuncture and Chinese medicine (DACM) from Pacific College of Health Sciences in 2021. She practices in Newport Beach, Calif., and is an inpatient staff member of Cedars Sinai Medical Center and the California Rehabilitation Institute [a Cedars Sinai / University of California, Los Angeles (UCLA) Health partnership].