P3C398: Deep Vein Thrombosis as a Complication of Traditional Cupping Therapy in a Pediatric Patient

Introduction: Deep vein thrombosis (DVT) is a venous thromboembolic disorder, representing the third most common cause of death from cardiovascular disease. Risk factors include reduced blood flow, increased venous pressure and increased blood viscosity. Chinese medicine believes certain conditions are caused by blocked qi, vital energy that flows through our body. Cupping is a technique thought to relieve these blockages by applying suction cups to skin points, creating a sub-atmospheric vacuum. Our case describes a 17-year-old patient who developed a DVT following cupping therapy. Our aim is to create awareness of a possible association between cupping therapy with DVT formation in the pediatric population.

Case Description: A healthy 17-year-old Hispanic male presented to the emergency department (ED) for a one-day history of right upper extremity (RUE) pain, swelling and discoloration. Day prior to presentation, patient was experiencing right shoulder pain and underwent cupping therapy after which he noticed RUE swelling and purple discoloration. He was seen at an outside hospital where ultrasound (US) of the RUE revealed an occlusive DVT in the right subclavian vein and was transferred to a Pediatric ED. Physical examination was remarkable for RUE swelling with deep red discoloration. Compartments were soft with good range of motion in all extremities. Initial lab work showed elevated D-Dimer at 1.63 ug/mL and Cr at 1.05 mg/dL, otherwise coagulation studies were unremarkable. US of RUE showed an expanded right subclavian vein with hypoechoic thrombus and no flow. The patient was admitted to the hospital, started on Enoxaparin and ultimately safely discharged home on Rivaroxaban for 3 months. At completion of treatment, he followed up with hematology where complete thrombophilia work-up was unremarkable and follow up US showed chronic non-occlusive RUE thrombus.

Discussion: This is the first case report of a previously healthy pediatric patient who developed a DVT following cupping therapy. Cupping is generally considered safe, however, due to the temporality of the events in this patient and lack of other risk factors for DVT, a causal relationship between cupping therapy and DVT can be proposed. Amongst the three components of the Virchow’s Triad of vascular thrombosis, endothelial injury was likely a contributing factor in this patient’s case as cupping may induce tissue inflammation or edema around the veins resulting in turbulent blood flow and blockage. No similar cases have been described prior to this, per our literature review.

Conclusion: This case demonstrated the occurrence of DVT after cupping therapy in a pediatric patient. There is no prior causal relationship reported between this form of Chinese medicine and DVT formation in children, however, it may serve as a reminder that although critical adverse events related to cupping therapy are reportedly rare, issues may still arise leading to life threatening complications.