A case of unprovoked venous thromboembolism in a marathon athlete presenting atypical sequelae: What are the chances?

Abstract

Marathon runners are exposed to multiple thrombogenic risk factors including dehydration and hemoconcentration, injury and inflammation, long-distance travel between events, and contraceptive usage. However, despite awareness about thromboembolism and several case reports detailing life-threatening hypercoagulopathies in athletes, the prevalence of venous thromboembolism in marathon runners remains uncharted. There is a lack of data and evidence-based guidelines for these athletes and for healthcare providers, including general medical practitioners and sports physicians. We present an episode of unprovoked deep vein thrombosis (DVT) and pulmonary embolism (PE) in a female marathon athlete who presented with atypical sequelae over the course of 8 months, and identify some "easy-to-miss" warning signs and symptoms. Through dialogue with the patient regarding their personal questions and anxieties surrounding idiopathic DVT-PE, we identify a clear need for more accessible information and comprehensive research concerning the detection, prevalence, and long-term management of venous thromboembolism in athletes. We discuss the possibility that being an athlete might constitute a more significant risk factor for venous thromboembolism than is currently estimated by commonly used diagnostic protocols and conclude that there is quite possibly a need for more specific clinical guidelines for athletes in this area.

Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

“…7 In addition, Kahn et al concluded that early engagement in physical exercise after an acute DVT may not only be safe but also help reduce the risk of developing post-thrombotic syndrome and its long-term adverse consequences. 8 However, several cases of unprovoked VTE, [9][10][11][12][13][14][15][16] and even of acute coronary thrombosis, 17,18 have been described in endurance athletes, suggesting that the effect of high-intensity physical exercise on blood coagulation may not be entirely dismissed. Notably, Hull and Harris identified several putative thrombogenic risk factors in endurance athletes engaged in intensive exercise for long periods of time, including dehydration and hemoconcentration, injury and inflammation, microtrauma to blood vessel walls, immobilization during longdistance travel, use of doping substances with prothrombotic potential, bradycardia and low blood pressure, thoracic outlet obstruction, and May-Thurner syndrome, along with narrowing of inferior vena cava.…”

Marathon Maladies: Venous Thromboembolism Risk Associated with Marathon Running

“…In addition, bradycardia and hypotension as a result of training are not uncommon characteristics of endurance athletes (29). Hypothetically, low circulatory blood flow at rest may increase risk of VTE, particularly in combination with long periods of tapering, low activity, and prolonged travel (ie, venous stasis); though this has yet to be examined to the best of our knowledge (11). Extreme height (ie, shorter or taller than average) may influence hemostatic balance.…”

Modified thrombin formation and fibrinolysis in an ultra‐endurance marathon swimmer

“…Finally, we may conclude that prolonged endurance exercise, including ultra-endurance swimming, may alter coagulation and fibrinolysis processes, which may cause an imbalance in hemostasis, 14 particularly in aged athletes. The maintenance of proper hemostasis in marathon swimmers deserves more detailed study.…”