Venous thromboembolic (VTE) events (deep vein thrombosis (DVT) and pulmonary embolism (PE)), have been reported in otherwise healthy athletes following acute bouts of aerobic exercise.
PURPOSE: To review case reports and assess the commonalities of athletic individuals diagnosed with VTE, as well as the return-to-play recommendations prescribed by their physicians.
METHODS: We reviewed reports (n=14) of trained individuals (mean±sd; age 30.9 ± 15.3; F/M = 8/6) who were diagnosed with DVT and/or PE following a bout of aerobic exercise. We assessed frequency of VTE risk factors, symptoms with which patients presented, and return-to-play recommendations presented by clinicians. Age comparisons between the female and male groups were assessed by a one-way ANOVA.
RESULTS: Of the 14 cases of diagnosed VTE reported in healthy trained athletes, seven patients (50%) were diagnosed with PE, four (28.6%) with DVT, and three (21.4%) with both DVT and PE after a bout of vigorous exercise (11.7±3.0 METs). Female patients were on average younger than males (22.6±5.9 vs. 41.8±17.7; p=0.014). The most frequently reported commonality was the presentation of symptoms after a period of prolonged inactivity (> 1 hour) following an aerobic exercise bout, seen in nine (64.3%) individuals. Additionally, seven (87.5%) of the eight women were oral contraceptive (OC) users. Only two (12.3%) individuals were diagnosed with an inherited clotting disorder. Five cases (35.7%) did not report return-to-play recommendations, and those who did varied widely, with six (42.9%) clinicians recommending a range of physical activity restrictions, and three (21.5%) clinicians advising use of compression garments.
CONCLUSIONS: Female athletes presenting with VTE were significantly younger than male athletes, and most were using OCs, suggesting that the mechanisms underlying VTE may differ in men vs. women. Moreover, the frequency with which a period of inactivity preceded VTE also supports the possibility that aerobic exercise in combination with other risk factors can exacerbate VTE independent of underlying preexistent coagulatory disease. This information may help clinicians better prevent, diagnose and treat VTE in athletic patients and also highlights the need for better defined return-to-play guidelines for athletes following VTE.