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Hypercoagulability in athletes

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Current Sports Medicine Reports

Abstract

Risk factors for thromboembolism are well known, and athletes are placed under conditions that can result in exposure to several of these risk factors, which include travel, trauma, immobilization, hemoconcentration, and polycythemia. Presence of a genetic hypercoagulable disorder adds additional risk. Overall management is no different than in nonathletes. Thrombolysis is strongly recommended for upper extremity deep venous thrombosis (DVT) coupled with surgical decompression of obstructive structures if indicated. Thrombolytic therapy does not appear to be necessary for treatment of lower extremity DVT. Prevention of DVT with travel can be achieved through general techniques such as leg exercises, hydration, and loose fitting clothes. Aspirin before travel shows some benefits of protection, but individuals at higher risk may need low molecular weight heparin. Athletes should be screened during preparticipation physicals for thromboembolic risk. Individuals on anticoagulation therapy should not participate in collision or contact sports. Return to play with gradual increase in intensity is recommended with careful monitoring for recurrent venous thromboembolism and management of post-thrombotic symptoms.

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References and Recommended Reading

  1. Goldhaber SZ: Epidemiology of pulmonary embolism and deep vein thrombosis. In Haemostasis and Thrombosis. Edited by Bloom AL, Forbes CD, Thomas DP, Tuddenham EG. New York: Chrurchill Livingstone; 1994:1327.

    Google Scholar 

  2. Brandjes DPM, Buller HR, Heijboer H, et al.: Randomised trial of the effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997, 349:759–762.

    Article  CAS  PubMed  Google Scholar 

  3. Hilberg T, Moessmer G, Hartard M, Jeschke D:APC resistance in an elite female athlete. Med Sci Sports Exerc 1998, 30:183–184.

    CAS  PubMed  Google Scholar 

  4. Hilberg T, Moessmer G, Hartard M, Jeschke D: APC resistance in high elite athletes. Med Sci Sports Exerc 1998, 30(Suppl):279.

    Article  Google Scholar 

  5. Eichner ER: Athletes in airplanes: some are born to clot. Sports Med Dig 2000, 22:140–142.

    Google Scholar 

  6. Joffe HV, Goldhaber SZ: Upper-extremity deep venous thrombosis. Circulation 2002, 106:1874–1880. Discussion of pathophysiology and current treatment of UEDVT.

    Article  PubMed  Google Scholar 

  7. Prandoni P, Bernardi E: Upper extremity deep vein thrombosis. Curr Opin Pulm Med 1999, 5:222–230. Offers additional opinion regarding UEDVT management.

    Article  CAS  PubMed  Google Scholar 

  8. Yilmaz EN, Vahl AC, van Heek NT, et al.: Long-term results of local thrombolysis followed by first rib resection: an encouraging clinical experience in treatment of subclavian vein thrombosis. Vasc Surg 2000, 34:17–23. Offers additional opinion regarding UEDVT management.

    Article  Google Scholar 

  9. Federman DG, Kirsner RS: An update on hypercoagulable disorders. Arch Intern Med 2001, 161:1051–1056. Reviews most hypercoagulable disorders and their frequencies.

    Article  CAS  PubMed  Google Scholar 

  10. Rosendaal FR, Koster T, Vandenbrouke JP, Reitsma PH: High risk of thrombosis in patients homozygous for factor V Leiden (activated protein C resistance). Blood 1995, 85:1504–1508.

    CAS  PubMed  Google Scholar 

  11. Huisman MV, Rosendaal F: Thrombophilia. Curr Opin Hematol 1999, 6:291–297.

    Article  CAS  PubMed  Google Scholar 

  12. Poort SR, Rosendaal FR, Reitsma PH, Bertina RM: A common genetic variant in the 3′-untranslated region of the prothrombin gene is associated with elevated plasma prothrombin levels and an increase in thrombosis. Blood 1996, 88:3698–3703.

    CAS  PubMed  Google Scholar 

  13. Harris JM, Abramson N: Evaluation of recurrent thrombosis and hypercoagulability. Am Fam Physician 1997, 56:1591–1600.

    CAS  PubMed  Google Scholar 

  14. Lane DL, Mannucci PM, Bauer KA: Inherited thrombophilia: part 1. Thromb Haemost 1996, 76:651–662.

    CAS  PubMed  Google Scholar 

  15. Hilberg T, Jeschke D, Gabriel HHW: Hereditary thrombophilia in elite athletes. Med Sci Sports Exerc 2002, 34:218–221.

    Article  CAS  PubMed  Google Scholar 

  16. Ware JA, Heistad DA: Platelet-endothelium interactions. N Engl J Med 1993, 328:628–635.

    Article  CAS  PubMed  Google Scholar 

  17. Bliss S, Weinberger S, Meier M, Saint S: The unusual suspect. N Engl J Med 2002, 347:1876–1881.

    Article  PubMed  Google Scholar 

  18. Hagen TJ, Jenkinson DM, Rundell KW: Upper extremity painbodybuilding. Med Sci Sports Exerc 2002, 34(Suppl 1):S137.

    Article  Google Scholar 

  19. King FJ, Patel B, Nicholas JJ: Effort thrombosis syndrome (Paget-Schroetter syndrome) presenting as multiple pulmonary emboli. Am J Phys Med Rehabil 2000, 79:212.

    Article  Google Scholar 

  20. Simon LM: Leg pain-marathon runner. Med Sci Sports Exerc 2002, 34(Suppl 1):S44.

    Article  Google Scholar 

  21. deWeber K: Effort thrombosis with sepsis. Physician Sportsmed 1999, 27:74–86.

    Article  CAS  Google Scholar 

  22. Sotta RP: Vascular problems in the proximal upper extremity. Clin Sports Med 1990, 9:379–388.

    CAS  PubMed  Google Scholar 

  23. Nemmers DW, Thorpe PE, Knibbe MA, et al.: Upper extremity venous thrombosis: case report and literature review. Orthop Rev 1990, 19:164–172.

    CAS  PubMed  Google Scholar 

  24. Parziale JR, Akelman E, Weiss AP, et al.: Throacic outlet syndrome. Am J Orthop 2000, 29:353–360.

    CAS  PubMed  Google Scholar 

  25. Arko FR, Harris EJ, Zarins CK, Olcott C IV: Vascular complications in high-performance athletes. J Vasc Surg 2001, 33:935–942.

    Article  CAS  PubMed  Google Scholar 

  26. Ertl AC, Bernauer EM, Hom CA. Plasma volume shifts with immersion at rest and two exercise intensities. Med Sci Sports Exerc 1991, 23:450–457.

    Article  CAS  PubMed  Google Scholar 

  27. Whittlesey MJ, Maresh CM, Armstrong LE, et al.: Plasma volume responses to consecutive anaerobic exercise tests. Int J Sports Med 1996, 17:268–271.

    Article  CAS  PubMed  Google Scholar 

  28. Heit JA, Silverstein MD, Mohr DN, et al.: Risk factors for deep vein thrombosis and pulmonary embolism: a populationbased case-control study. Arch Intern Med 2000, 160:809–815.

    Article  CAS  PubMed  Google Scholar 

  29. Meissner MH, Chandler WL, Elliott JS: Venous thromboembolism in trauma: a local manifestation of systemic hypercoagulability? J Trauma 2003, 54:224–231.

    Article  PubMed  Google Scholar 

  30. Ferrari E, Chevallier T, Chapelier A, Baudouy M: Travel as a risk factor for venous thromboembolic disease: a case-control study. Chest 1999, 115:440–444. Provides support for association between travel and thromboembolism.

    Article  CAS  PubMed  Google Scholar 

  31. Bendz B, Sevre K, Andersen TO, Sandset PM: Low molecular weight heparin prevents activation of coagulation in a hypobaric environment. Blood Coagul Fibrinolysis 2001, 12:371–374.

    Article  CAS  PubMed  Google Scholar 

  32. Bendz B, Rostrup M, Sevre K, et al.: Association between hypobaric hypoxia and activation of coagulation in human beings. Lancet 2000, 356:1657–1658.

    Article  CAS  PubMed  Google Scholar 

  33. Kim V, Spandorfer J: Epidemiology of venous thromboembolic disease. Emerg Med Clin North Am 2001, 19:839–859.

    Article  CAS  PubMed  Google Scholar 

  34. Berglund B: High-altitude training. Aspects of haematological adaptation. Sports Med 1992, 14:289–303.

    Article  CAS  PubMed  Google Scholar 

  35. Powell FL, Garcia N: Physiological effects of intermittent hypoxia. High Alt Med Biol 2000, 1:125–136.

    Article  CAS  PubMed  Google Scholar 

  36. Jha SK, Anand AC, Sharma V, et al.: Stroke at high altitude: Indian experience. High Alt Med Biol 2002, 3:21–27. Gives support to idea that polycythemia increases susceptibility to thrombus.

    Article  PubMed  Google Scholar 

  37. Eichner ER: Better dead than second. J Lab Clin Med 1992, 120:359–360.

    Google Scholar 

  38. Spivak JL: EPO in thalassemia minor: is it doping? Sports Med Dig 2002, 24:103.

    Google Scholar 

  39. Shaskey DJ, Green GA: Sports haematology. Sports Med 2000, 29:27–38.

    Article  CAS  PubMed  Google Scholar 

  40. Berglund B, Ekblom B: Effect of recombinant human erythropoietin treatment on blood pressure and some haematological parameters in healthy men. J Int Med 1991, 229:125–130.

    Article  CAS  Google Scholar 

  41. Todd MK, Goldfarb AH, Kauffman RD, Burleson C: Combined effects of age and exercise on thromboxane B2 and platelet activation. J Appl Physiol 1994, 76:1548–1552.

    CAS  PubMed  Google Scholar 

  42. Wang J, Jen CJ, Kung H, et al.: Hypertension/exercise: Different effects of strenuous exercise and moderate exercise on platelet function in men. Circulation 1994, 90:2877–2885.

    Article  CAS  PubMed  Google Scholar 

  43. Ahmadizad S, El-Sayed M: The effects of graded resistance exercise on platelet aggregation and activation. Med Sci Sports Exerc 2003, 35:1026–1032.

    Article  PubMed  Google Scholar 

  44. Vandenbroucke JP, Koster T, Briet E, et al.: Increased risk of venous thrombosis in oral-contraceptive users who are carriers of factor V leiden mutation. Lancet 1994, 344:1453–1457.

    Article  CAS  PubMed  Google Scholar 

  45. Urschel HC Jr, Razzuk MA: Paget-Schroetter syndrome: what is the best management? Ann Thorac Surg 2000, 69:1663–1668.

    Article  PubMed  Google Scholar 

  46. Sharafuddin MJ, Sun S, Hoballah JJ: Endovascular management of venous thrombotic diseases of the upper torso and extremities. J Vas Interv Radiol 2002, 13:975–990.

    Article  Google Scholar 

  47. Schulman S: Care of patients receiving long-term anticoagulant therapy. N Engl J Med 2003, 349:675–683. Review of studies for long-term therapy with warfarin. Discusses benefits and risks for low- and high-dose warfarin therapies.

    Article  PubMed  Google Scholar 

  48. Partsch H, Blatter W: Compression and walking versus bed rest in the treatment of proximal deep venous thrombosis with low molecular weight heparin. J Vasc Surg 2000, 32:861–868.

    Article  CAS  PubMed  Google Scholar 

  49. Adelman MA, Stone DH, Riles TS, et al.: A multidisciplinary approach to the treatment of Paget-Schroetter syndrome. Ann Vasc Surg 1997, 11:149–154.

    Article  CAS  PubMed  Google Scholar 

  50. Kreienberg PB, Chang BB, Darling RC III, et al.: Long-term results in patients treated with thrombolysis, thoracic inlet decompression, and subclavian vein stenting for Paget-Schroetter syndrome. J Vasc Surg 2001, 33:S100-S105. Provides prognosis for patients with UEDVT.

    Article  CAS  PubMed  Google Scholar 

  51. Hicken GJ, Ameli M: Management of subclavian-axillary vein thrombosis: a review. Can J Surg 1998, 41:13–25.

    CAS  PubMed Central  PubMed  Google Scholar 

  52. Lensing AWA, Prandoni P, Prins MH, Buller HR: Deep-vein thrombosis. Lancet 1999, 353:479–485.

    Article  CAS  PubMed  Google Scholar 

  53. DiFelice GS, Paletta GA Jr, Phillips BB, Wright RW: Effort thrombosis in the elite throwing athlete. Am J Sports Med 2002, 30:708–712.

    PubMed  Google Scholar 

  54. De Stefano V, Martinelli I, Mannucci PM, et al.: The risk of recurrent deep venous thrombosis among heterozygous carriers of both factor V Leiden and the G20210A prothrombin mutation. N Engl J Med 1999, 341:801–806.

    Article  PubMed  Google Scholar 

  55. Khamashta MA, Cuadrado MJ, Mujic F, et al.: The management of thrombosis in the antiphospholipid-antibody syndrome. N Engl J Med 1995, 332:993–997.

    Article  CAS  PubMed  Google Scholar 

  56. Allaart CF, Poort SR, Rosendaal FR, et al.: Increased risk of venous thrombosis in carriers of hereditary protein C deficiency defect. Lancet 1993, 341:134–138.

    Article  CAS  PubMed  Google Scholar 

  57. Ridker PM, Goldhaber SZ, Danielson E, et al.: Long-term, lowintensity warfarin therapy for prevention of recurrent venous thromboembolism. N Engl J Med 2003, 348:1425–1434. Important for discussion of long-term management for patients with recurrent thromboembolism.

    Article  CAS  PubMed  Google Scholar 

  58. Kearon C, Ginsberg JS, Kovacs MJ, et al.: Comparison of low-intensity warfarin therapy with conventional-intensity warfarin therapy for long-term prevention of recurrent venous thromboembolism. N Engl J Med 2003, 349:631–639. Important for discussion of long-term management for patients with recurrent thromboembolism.

    Article  CAS  PubMed  Google Scholar 

  59. Pulmonary Embolism Prevention (PEP) Trial Collaborative Group: Prevention of pulmonary embolism and deep vein thrombosis with low dose aspirin: Pulmonary Embolism Prevention (PEP) trial. Lancet 2000, 355:1295–1302.

    Article  Google Scholar 

  60. American Academy of Pediatrics Committee on Sports Medicine and Fitness: Medical conditions affecting sports participation. Pediatrics 2001, 107:1205–1209.

    Article  Google Scholar 

  61. Roberts WO, Christie DM, Jr: Return to training and competition after deep venous calf thrombosis. Med Sci Sports Exerc 1992, 24:2–5.

    Article  CAS  PubMed  Google Scholar 

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  1. DeWitt Army Community Hospital, 9051 Farrell Road, Suite GC 11, 22060, Ft. Belvoir, VA, USA

    Thomas Howard MD

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  1. Christopher Meyering DO
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Meyering, C., Howard, T. Hypercoagulability in athletes. Curr Sports Med Rep 3, 77–83 (2004). https://doi.org/10.1007/s11932-004-0005-1

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