18 | Special Topic Supplement: VENOUS THROMBOEMBOLISM
For athletes, especially those using their arms, the muscles
can get large and contribute to the narrowing of the outlet.
In this situation, repetitive injury to the vein going through
that narrowed outlet sets the stage for a clot forming in the
vein. These clots can cause swelling and pain of the arm,
and sometimes numbness. Like leg clots, they can travel to
the lungs causing pulmonary embolism. Treatment is with
anticoagulant medications and often surgery is used to
open up the outlet so that clots might not form again.
Injuries are a major source of risk for clots, especially
leg injuries when there is immobility afterward. The worst
example of this is leg fracture with casting. However, minor
injuries also increase the risk somewhat; this is likely a
factor for hockey players as they often get hit by the puck.
Surgery greatly increases the risk of blood clots for a
period of several weeks. The risk is greater for orthopedic
than general surgery, so it is a factor for athletes. In
2013, NBA Star Anderson Varejao had a great season
with the Cavaliers cut short when he developed back
and chest pain from a PE shortly after surgery on his
quadriceps. Showing that this doesn’t have to end a sports
career, Mr Varejao apparently had a finite treatment with
anticoagulation and later resumed play.
Like anyone else, genetics plays a role for athletes.
Kimmo Timonen, four-time NHL All Star with the
Philadelphia Flyers developed a leg DVT and PE in 2014.
He had had less serious superficial clots (in veins just under
the skin) previously, which we know is a risk factor for
DVT and PE. He was found to have protein C deficiency
a genetic condition that contributes to blood clot risk by
lowering the body’s ability to stop formation of clots.
Travel. Pro athletes travel a lot. We know that long
travel slightly increases the risk of clots.
Birth control pills increase the risk of clots in women.
This risk is highest in the first year of use and in women
who have obesity or are older when using them, and
continues until the pills are stopped.
Can athletes with clots
continue to play their sport?
There are no medical guidelines on the best treatment
for athletes so we customize treatment recommendations
the same way we do for non-athletes. If the blood
clot was limited to the arm veins or triggered by
surgery, trauma or immobilization, usually 3 months of
anticoagulation is adequate treatment.
If the clot occurs spontaneously, even one episode
of clotting can mean a recommendation for long-term
treatment with blood thinning medication. Long-term
treatment is also common for people who experience
clots on more than one occasion, especially if they have
For professional athletes, this might mean the end
of their career, although every sport is different. Golf,
are a major
source of risk