International Journal of Trend in Scientific Research and Development (IJTSRD)

Volume 7 Issue 5, September-October 2023 Available Online: www.ijtsrd.com e-ISSN: 2456 – 6470

Leech Therapy in DVT (Deep Venous Thrombus): A Case Study

Dr. Sonia Shekhawat1, Dr. Devesh Shukla2, Dr. Rajeev Kumar3, Dr. Jeeshan Khan4
1
PG Scholar, Shalya Tantra Department, Gurukul Campus, Haridwar,
2
Associate Professor, Shalya Tantra Department, Gurukul Campus, Haridwar,
3
Assistant Professor, Shalya Tantra Department, Gurukul Campus, Haridwar,
1, 2, 3
Uttarakhand Ayurveda University, Dehradun, Uttarakhand, India
4
PG Scholar, Rachana Sharir Department, Shri Krishna Government Ayurvedic College,
Shri Krishna Ayush University, Kurukshetra, Haryana, India

ABSTRACT How to cite this paper: Dr. Sonia

Deep venous thrombus (DVT) is an acute thrombus of the deep Shekhawat | Dr. Devesh Shukla | Dr.
veins. Postoperative immobilization, pressure on the calf muscles, Rajeev Kumar | Dr. Jeeshan Khan
sluggish blood flow, and prolonged bed rest are the various factors "Leech Therapy in DVT (Deep Venous
which precipitate deep vein thrombosis. In this case study, the patient Thrombus): A Case Study" Published in
International
had left lower limb DVT after LSCS (Low segment Caesarean Journal of Trend in
section). Jalauka’s saliva has many enzymes and chemicals that Scientific Research
inhibit blood coagulation and have thrombolytic effects. Acharya and Development
Charaka, Acharya Sushruta and Acharya Vagbhata mentioned (ijtsrd), ISSN:
Raktavishrvan in Raktaja roga. So, to evaluate the efficacy of 2456-6470,
Jalauka in DVT I take this as case study and I was successful in the Volume-7 | Issue-5, IJTSRD59956
treatment of DVT through Jalauka. October 2023,
pp.486-492, URL:
KEYWORDS: DVT, Jalauka, Raktaja roga www.ijtsrd.com/papers/ijtsrd59956.pdf

Copyright © 2023 by author (s) and

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I. INTRODUCTION
The most common presentations of venous 1. Stasis
thrombosis are deep vein thrombosis (DVT) of the 2. Venous endothelial injury
lower extremity and pulmonary embolism. Venous 3. Hypercoagulability of the blood
thrombus is a very common surgical problem, which These three are knows as Virchow’s triad.
has great influence on the morbidity and mortality of
surgical patients. DVT is the 3rd most frequent Types of venous thrombus: Mainly two types of
vascular illness after ischemic heart disease (IHD) venous thrombosis are seen.
and stroke. 1. Thrombophlebitis – This is mainly seen in the
superficial veins, particularly in varicose vein or
EPIDEOMOLOGY: in veins which have been cannulated for infusion.
During pregnancy and after childbirth, acute VTE in In these case, venous thrombosis is associated
about 1.2 of 1000 deliveries. Despite it being with acute inflammatory response giving rise to
relatively rare, it is a leading cause of maternal pain, local swelling, redness and tenderness.
morbidity and mortality. Populations in Asia have
Although acute inflammatory changes occur in
VTE rates 15 to 20%.1 the vein wall, bacteria are rarely present.
AETIOLOGY:
2. Phlebothrombosis (deep vein thrombosis) – Here
Three factors play major roles in etiology of venous the thrombus produces little local sign or
thrombosis. These are-
symptoms and may be loosely attached to the vein

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wall, so that emboli may be dislodged from this flex or move the leg. If there is massive
thrombus to cause fatal pulmonary embolism. thrombosis there may be an extremely severe
aching at the site of the thrombosis.
Proximal DVT is one that is located in the popliteal,
femoral, or iliac veins.  Leg is tense, tender, warm, pale or bluish with
Isolated distal DVT has no proximal component, is stretched and shiny skin.
located below the knee, and is confined to the calf  Positive Homan’s sign – passive forceful
veins (peroneal, post., ant. tibial and muscular veins) dorsiflexion of the foot with extended knee will
CAUSES OF DVT: cause tenderness in the calf.
 Postoperative thrombosis (Most common cause) –  Mose’s sign – gentle squeezing of lower part of
common after the age of 40 years. Incidence the calf from side-to-side is painful. Gentleness is
following surgeries is 30%. In 30% cases both very important otherwise it may dislodge a
legs are affected. Usually seen after prostate thrombus to form an embolus.
surgery, hip surgery, major abdominal surgeries,
 Most often, DVT is asymptomatic and presents
gynaecological surgeries, cancer surgeries.
suddenly with features of pulmonary embolism
Bedridden more than 3 days in the postoperative
like chest pain, breathlessness and haemoptysis.
period increases the risk of DVT. Prothrombotic
states / Inherited hypercoagulable states DIFFERENTIAL DIAGNOSIS FOR DVT:
 Ruptured Baker’s cyst, Ruptured plantaris tendon,
 Trauma-to leg, ankle, thigh, pelvis
Calf muscle haematoma, Cellulitis leg,
 Muscular violence Superficial thrombophlebitis
 Immobility-bedridden patients, individuals on INVESTIGATIONS:
long duration air or bus travel (Traveller’s  Blood counts – to rule out polycythemia
thrombosis)
 D-dimer – can also be positive in cancer,
 Polycythemia vera, thrombocytosis pneumonia, sepsis and MI
 Deficiencies of Antithrombin 3rd, Protein C or S  USG veins/Doppler study of veins, Venography
deficiency, Factor V Leiden mutation, (Ascending contrast venography)
thrombophilia
 USG Abdomen – to rule out malignancy
 Recent myocardial infarction, heart failure,
nephrotic syndrome  Chest X-ray - to rule out malignancy
 Thrombosis can occur in individuals who sit with  Procoagulant work up
computers for long time - ethrombosis  In pulmonary embolism – Chest MDCT
 Hormone therapy – OCPs (Multidetector CT) / CT Pulmonary Angiogram /
 Smoking Ventilation-perfusion scan
 Splenectomy – leads to thrombocytosis TREATMENT:
1. Bed rest – this is to allow thrombi to become
 Pregnancy – is associated with an increased risk adherent to the vein wall. It also prevents
of thrombosis, 5-50 times higher in pregnant formation of pulmonary embolus.
versus non-pregnant women, that may be due to
obstruction of IVC by the enlarged uterus, as well 2. Elevation of legs above the heart level –
as the hypercoagulation state associated with preventing venous stasis and formation of new
pregnancy. thrombi.
In the days and weeks after surgery, a higher chance 3. Elastic stoking, standing and sitting ideally should
of developing a deep vein thrombosis (DVT). They be prohibited
are most common in the leg. In this case study, LSCS 4. Anticoagulants- LMWH, warfarin, phenindione.
done on dated 01-01-2022. Patient do walk on 3rd day Oral anticoagulants being teratogenic cannot be
(03-01-2022), leg movement do on bed on 2nd day used during pregnancy. LMWH is the drug of
(02-01-2022). choice used during pregnancy and postpartum
CLINICAL FEATURES: period.
 Fever – earliest symptom. 5. Coumarin derivatives
 Pain and swelling in the calf and thigh. Pain is 6. Fibrinolytic drugs - streptokinase
often so severe that the patient finds it difficult to

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7. Aspirin Residence: Kotdwar, Uttarakhand, India
8. Surgery Hospital Name: OPD No.-07 (Shalya Tantra OPD),
Gurukul Campus, Haridwar, Uttarakhand Ayurveda
PREVENTION OF DVT: University, Dehradun.
 Reposition the patient every 2 hours following
surgery or more frequently as ordered and for 2. Chief Complaints-
comfort. Pain and swelling in left lower limb and thigh since 4
months
 Perform or ask the patient to perform frequent
passive or active ROM exercises.
 Promote early ambulation following surgery
 Apply antiembolism/compression stockings or an
intermittent pneumatic compression device
 Apply graduated compression stockings
according to manufacturer’s written instructions.
Remove every 8 hours, or according to facility
protocol, to assess skin and for DVT.
 Maintain adequate hydration to prevent
hemoconcentration.
 Administer prescribed anticoagulants to prevent
thrombus formation, monitor for bleeding and
review laboratory test results for coagulation
studies.
 Smoking increases the viscosity of blood and so
should be stopped.
 Patient on oral contraceptive or oestrogens should
stop the drug 6-8 weeks prior to any elective
surgery.
COMPLICATIONS OF DVT:
 Pulmonary embolism: cough, chest pain, acute
right ventricular dilatation and failure.
 Infections, venous gangrene
 Chronic venous hypertension around the ankle
region causing venous ulcers – chronic venous
insufficiency – CVI
 Recurrent DVT
 Propagation of thrombus proximally
II. CASE REPORT
1. Particulars of the patient-
Patient name: Shweta
Age: 23 Years
Sex: Female
OPD NO.- 9360
IPD NO.- 1009
Ward/Bed No.- 2/16
Phone NO. 88……26
Date: 13-05-2022
Religion: Hindu
Social Status: Middle
Occupation: Housewife Fig 1.1 Note the swelling in the thigh and leg

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3. History of Present Illness- 5. Obs. History-
Before coming to gurukul campus, Haridwar, she P1L1
consulted Chandramohan Singh Negi Govt. Base
P1 = Boy/01-01-2022, 12:30 am/Kotdwar Govt.
Hospital, Kotdwar, dated 31-01-2022, slip no. 9001,
Hosp./3.5Kg/LSCS/Cord around neck
where she presented with Pain and swelling in the
thigh and leg (swelling from inguinal ligament to 6. Surgery history-
heel), unable to walk, fever since 10days, history of LSCS- 01-01-2022
LSCS 1 month back and diagnosed with DVT Lt. Patient do walk on 3rd day (03-01-2022), leg
lower limb after LSCS by color doppler of left lower movement do on bed on 2nd day (02-01-2022)
limb. After those 2 days (02-02-2022), she consulted
at the Shri Guru Ram Rai Institute of Medical & 6.1. Drug History-Not
Health sciences, Dehradun and the patient presented 6.2. Allergy History- Not
with the left lower limb and thigh swelling, for which
she was admitted (02-02-2022), investigated & 7. Personal History –
diagnosed as Left lower limb DVT Post LSCS. Smoking: No
Patient was managed conservatively. The patient is Drinking of alcohol: No
being discharged (07-02-2022) under satisfactory Diet: Regular, veg., not takes spicy food
general condition. After 3 months, the patient visited Marital status: Married
Gurukul campus, Haridwar, UAU, Dehradun for 8. Family History- none
better management at 13th may,2022. According to
9. Physical examination
the patient’s statement, it was found that pain was so
9.1. Local Examination-
severe that the patient finds it difficult to walk, not
9.1.1. Inspection: swelling present over left leg and
radiating to any other part. She has no history of
thigh.
HTN, DM, trauma or previous surgery except LSCS.
9.1.2. Palpation:
4. Past History-
No DM, TB, HTN. 1. Tenderness, Homan’s and Moses’s sign were
not done because it dislodges emboli to cause
No any history of trauma and operation except LSCS
pulmonary embolism
10. Investigations-
01-02-2022
1. Color doppler Lt. Lower Limb-
Subacute thrombosis of Lt. external iliac and Lt. popliteal vein
02-02-2022
2. RFT
Urea-22 mg/dl Creatinine 0.4mg/dl uric acid 2.1mg/dL albumin 3.40 g/Dl globulin 4.00 g/dL
Serum alkaline phosphatase, S. Na, S. K, S. Phosphorus, S. total cholesterol: within normal limit
3. LFT
T.BIL-0.7mg/dL SGOT-46 U/L SGPT-42U/L albumin 3.40 g/Dl globulin 4.00 g/dL
Serum GGT–10U/L Serum Bilirubin conjugated – 0.0 mg/dl
3. Prothrombin Time (PT) / INR
Test PT 9.8 11.0 - 16.0 Sec. Nephelometry
INR 0.890 1.000 – 1.300 Sec.
4. D-Dimer, Quantitative Immunoturbidimetry
D-Dimer H 6000 <255 ng/mL
5. COMPLETE HAEMOGRAM/CBC
Haemoglobin (Hb) 10.9 12.0 – 15.0 gm/Dl
Neutrophils 68.9 44.0 – 68.0 %
Lymphocytes 21.5 25.0 – 48.0 %
RBC 3.59 3.80 – 4.80 millions/cu.mm
PCV 34.2
Other elements value is within normal limit.
6. RDW
RDW Histogram 12.10 11.60-14.10 CV% Derived by RBC
03-02-2022

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8. SARS-COV-2 (COVID-19) Real-time PCR - Negative
9. X-RAY- CHEST PA-VIEW Normal study
10. Urine examination no significant abnormality detected
04-02-2022
11. USG WHOLE ANDOMEN No significant abnormality detected
12. ECHO CARDIOGRAPHY & COLOR DOPPLER REPORT No significant abnormality detected
13. Serum Homocysteine 8.1 4.7 – 12.6 umol/L Enzymatic (Cystathionine betasynthase)
05-02-2022
14. Factor V Leiden, Mutant Detection positive (Heterozygous)
11. Clinical Diagnosis- Left lower limb DVT post LSCS
12. Treatment- Jalaukavacharana: 12 sittings at 7 days interval
Investigation prior to leech therapy-
BT, CT, HBs Ag, HCV, HIV
Jalaukavacharana Vidhi -
 Poorva karma – Purification of leech by pouring the leech into water mixed with turmeric powder.
 Pradhana karma – Prick the skin with a sharp, sterile needle to release a drop of blood, then apply the leech
through its mouth end and cover it with wet cotton.
 Paschata karma –
• Leech removal: After 45 minutes, the leech usually leaves the site itself. If it doesn’t remove itself, then
apply turmeric powder to the leech’s mouth.
• Care of wound: After the leech has been detached, the mouth of the leech leaves a triangular wound. The use
of Jatyadi Ghrita with a tight bandage stops the bleeding from the wound.
• Jalauka’s Vamana: The leech used on the affected site will have to go through a vamana process so that it
can be used on the same patient again. Turmeric powder is put to the leech’s mouth for vamana. To purify
itself, the leech vomits impure suck blood. For good vamana, it is sometimes necessary to press the leech
from the caudal to the frontal end. After proper vamana, the leech should be placed in fresh water where it
will swim quickly, and it should be placed in a clean container filled with water having multiple pores on the
top for proper aeration.
• No. of sittings – 12 at 7 days interval.
Jalaukavacharana started on May 24th, 2022. Total 4 leeches were applied at each sitting; position of leech
applications is below inguinal ligament, popliteal fossa, medial and lateral malleolus. Total 12 sittings were
taken by patient after that color doppler study of left lower limb (Arterial and venous) was advised.

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Fig. 1.2 Leech therapy in Left lower limb DVT after LSCS
After completion of 12 sittings of leech therapy, color doppler study of left lower limb (arterial and venous) was
done and report is given below:
17-08-2022
COLOR DOPPLER STUDY OF LEFT LOWER LIMB (ARTERIAL AND VENOUS)
Impression- normal study of left lower limb arteries
No evidence of DVT in left lower limb
13. Assessment Criteria-
13.1. PAIN
EXPLANATION GRADE
No complaint of pain 0
Pain at long time standing position and 1-3 on face pain scale 1
Mild pain at rest and 4-6 on face pain scale 2
Severe pain at rest and 7-10 on face pain scale 3

13.2. SWELLING (present over the left thigh and leg)

EXPLANATION GRADE
Absent 0
Present 1

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13.3. Discolouration and non-healing ulcer
EXPLANATION GRADE
Absent 0
Present 1
13.4. Colour Doppler study of left lower limb
III. RESULT
BT AT
Pain Pain grade was 3 Pain grade was 0
Swelling on left lower limb Present Absent
Discoloration & non-healing ulcers Absent Absent
Colour Doppler study of left lower DVT in Left External  No evidence of DVT in left lower limb
limb iliac and popliteal vein  Normal study of left lower limb arteries.

IV. DISCUSSION doctors suggested injection heparin, warfarin, inferior

According to Acharya Sushruta, Raktmokshan have vena caval filters, and surgery as last resort. Surgeries
been done through 2 methods- are Palma operations and May-Husni operation. In
1. Shastra krita has 2 types – a. Prichaan vidhi, b. Ayurveda, only leech applications cure DVT
Siraveda. permanently.
2. Ashastra krita has three types – shringa, jalauka, REFERENCES:
and alabu. [1] https://en.wikipedia.org/wiki/Deep-vein-
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Acharyas. Acharya Vagbhata and Sushruta indicates with Ayurveda Tattva Sandipika,
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Enzymes and chemicals secreted by leech saliva
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