Reducing The Risk Of DVT / Blood Clots

The Cross Brace Protocol (CBP) requires your injured leg to be immobilised in a brace in order to optimise ACL healing. This restricted movement can slow down your blood flow, and is associated with an increased risk of DVT (deep vein thrombosis). Therefore, special care needs to be taken to prevent these potential DVTs / blood clots and their serious consequences. 1
By following the recommended advice of your doctor and physiotherapist your risk of DVT is significantly reduced.

This information is not a substitute for advice from your doctor, nor does it contain all the relevant facts. Your doctor will consider your personal circumstances. Please talk with your doctor about any concerns.

Things to consider​

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What medication can assist

When developing the CBP, a vascular physician and vascular surgeon were consulted about minimising the risk of potentially fatal blood clots. The recommended safety precaution is a prescription for an anticoagulant (blood thinning) medication, which will reduce the risk of DVTs. Note: Children aged under 13 years have a very low risk of DVT, therefore blood-thinning medication is not required.

The CBP recommends Xarelto (Rivaroxaban) 10mg nightly, to commence on day 1 of bracing and extended to the end of week 8 (until walking without crutches). NOTE: This should be considered in consultation with your physician.

When taking blood thinning medication, you may bleed or bruise more easily. Be careful when handling sharp objects such as razors or knives. If cut, your bleeding may last longer than usual.

What can I do to prevent DVT & Blood clots

Wearing compression stockings or tight exercise pants will also help reduce the risk of clotting. In addition, these compression garments also help control oedema (swelling) and protect your skin underneath the brace. Remember to take great care when taking these garments on and off, so you can maintain your necessary knee bend. Your physiotherapist will also recommend specific “calf pump” exercises to improve your circulation. Elevating your leg, when possible, will also reduce the risk.

Working with your physician

Your doctor or physiotherapist will ask if you have ever experienced a DVT. You will also be asked about recent long-distance travel, relevant medical history for you and your family, and whether you are taking medication that may increase the risk of blood clots (eg oral contraceptive pill for females). If you are considered high risk of DVT, your doctor may recommend you have a doppler ultrasound to rule out any existing blood clots before starting the CBP.

DVT signs to watch out for

  • throbbing pain in the injured leg, usually in the calf or thigh, especially when standing up.
  • swelling in the leg.
  • warm skin around the painful area, which may look red or darkened.


If any of these signs occur, contact your doctor or physiotherapist as soon as possible. If they are not available, go to your GP or to your nearest hospital emergency department.

1: Braithwaite I el al. Lower limb immobilisation and venous thromboembolism risk: combined case-control studies. Postgrad Med J. 2017


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