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Aquatic Therapy.... with a DVT?


Aquatic therapy is not universally contraindicated for individuals with deep vein thrombosis (DVT), but careful consideration of the timing and clinical context is essential.


Early mobilization, including walking, has been shown to be safe and beneficial in patients with acute DVT, leading to more rapid resolution of limb pain and similar short-term risk of pulmonary embolism compared to bed rest.[1]


This suggests that physical activity, in general, is not harmful and may be advantageous in managing DVT. However, the specific context of aquatic therapy involves immersion, which can have unique hemodynamic effects. Immersion in water increases venous return and central blood volume, which could theoretically increase the risk of thrombus dislodgement and subsequent pulmonary embolism. Despite this theoretical risk, there appears to be no direct evidence from the literature reviewed that specifically contraindicates aquatic therapy in patients with DVT.


The American Heart Association and American Stroke Association recommend early mobilization as part of DVT management to prevent complications such as pulmonary embolism.[2] This aligns with the general safety of physical activity in DVT patients, as supported by systematic reviews and clinical studies.[1][3]


In conclusion, while aquatic therapy is not explicitly contraindicated, it should be approached with caution. Individual risk assessment, including the stability of the thrombus and the patient's overall clinical status, is crucial. Consulting with a specialist in vascular medicine or a hematologist may provide additional guidance tailored to the specific patient scenario.


References

1.Kahn SR, Shrier I, Kearon C. Physical Activity in Patients With Deep Venous Thrombosis: A Systematic Review. Thrombosis Research. 2008;122(6):763-73. doi:10.1016/j.thromres.2007.10.011.


2. Adams HP, del Zoppo G, Alberts MJ, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology Affirms the Value of This Guideline as an Educational Tool for Neurologists.

Stroke. 2007;38(5):1655-711. doi:10.1161/STROKEAHA.107.181486.


3. Manganaro A, Ando G, Lembo D, Sutera Sardo L, Buda D. A Retrospective Analysis of Hospitalized Patients With Documented Deep-Venous Thrombosis and Their Risk of Pulmonary Embolism. Angiology. 2008 Oct-Nov;59(5):599-604. doi:10.1177/0003319707309655.

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