Tour de France rider suffers blood clot, be aware

Risk factors like blood doping?

I'm not at all surprised to see this happen to a Tour rider.

yes... or flying... or quite a few other things.

That's true and in this case it was most likely caused by the hematoma received in his crash.  Similar thing happened to Serena Williams:

http://www.cbsnews.com/stories/2011/03/02/sports/main20038228.shtml

I implied that Tour riders, are generally not clean and no, you don't have to forget I said it.

Wow, Tour riders in general? Why not all pro riders? Why not ALL riders?  Why not triathletes? 

Apologies to the OP for polluting your helpful PSA.  Given the severity of the Horner crash, he's lucky it wasn't a cerebral embolism.  If you saw the freaky footage of him being carted off, asking repeatedly if he'd finished, you'd think he's lucky to be alive.

I will say... that list looked like a joke, and I like almost every guy that scored a 0.

I always love the generic doping accusations with nothing to back it up

Thanks for bringing it back on topic.  Doping debaters, please go somewhere else.

Anyway, those are the two main ones, but there are others, including potentially the use of compression gear (which is debatable on recent studies), related to dehydration but avoid alcohol around racing, don't stop moving right after a race, walk around a bit and keep the blood flowing.  From the National Blood Clot Alliance article re: athletes:

• Take breaks and stretch legs when traveling long distances;

• Stay well hydrated (during and after a strenuous sporting event and travel);

• Know the symptoms of DVT and PE and seek early medical attention if they occur;

• Realize that DVT and PE can occur in the athlete;

• Know the risk factors for blood clots (see table 1);

• Know whether you have a family history of blood clots;

• In case of major surgery, trauma, prolonged immobility, or when in a cast: ask your doctor whether you should receive DVT prophylaxis and, if yes, for how long.

Curious as to why compression gear is debatable.  Don't they use compression socks, etc in hospitals for this reason? 

They do, but there was a recent hospital (can't recall the name) that stopped recommending them claiming they did not actually do anything to prevent DVTs

Here's 2010

2010

• On 29 January 2010, Italian Vania Rossi was reported positive for CERA by the Italian Olympic Committee. The Comitato Olimpico Nazionale Italiano (CONI) controlled Rossi on January 10 after she finished second in the women's national cyclocross championships. Her B sample subsequently came back negative. Rossi is the partner of Italian professional cyclist Riccardo Riccò, who himself tested positive for CERA at the 2008 Tour de France.^[374] Her B sample later came back negative, and she was cleared of all charges.^[375]

• On 11 March, Polish brothers Pawel and Kacper Szczepaniak, who finished first and second in the under 23 race of the 2010 UCI Cyclo-cross World Championships, have returned positive results for EPO, in controls carried out at the event which took place in Tabor, Czech Republic in January. The two had been targeted after suspicious blood profiles were revealed as part of their respective biological passports. Their B samples will have to be analysed before any suspension is handed out.^[376] A week later, Kacper Szczepaniak reportedly attempted to commit suicide.^[377]

• Manuel Vazquez Hueso of Spain was found, on 14 March, to have taken EPO, and in January 2011 the UCI handed down a fine of €35,000 and suspension until April 2012.^[378]

• On 16 March 2010, Alejandro Valverde's appeal against his ban from riding in Italy was rejected by the Court of Arbitration for Sport. It was confirmed that he could not ride on Italian soil again until 10 March 2011. A UCI press statement, issued after this hearing, stated that "the UCI expresses its determination to take the necessary measures to secure a suspension that is applicable internationally."^[379] The UCI President Pat McQuaid stated later that it will seek to extend Valverde's ban worldwide.^[380] On 27 March, McQuaid said that the UCI will wait to impose a worldwide ban on Valverde until CAS rules on an appeal by the UCI, protesting the fact that the Spanish cycling federation (RFEC) did not open disciplinary proceedings against Valverde. The CAS ruled on 31 May that the suspension could be enforced, and the UCI applied a retroactive two year suspension on Valverde from 1 January 2010. In additionto this, all of his results from 2010 were nullified.^[381]

• On 6 April 2010, Italian newspaper La Gazzetta dello Sport revealed that a doping investigation based around the town of Mariana Mantovana in Lombardy had been commenced by Italian police. It reported that the investigation could involve 54 people relating to events in the 2008 and 2009 seasons. The cycling coach/doctor Guido Negrelli, who has worked in the past with Lampre riders and the team manager Giuseppe Saronni is allegedly at the centre of the investigation. Lampre-Farnese Vini's team doctors and two riders, Alessandro Petacchi and Lorenzo Bernucci, had their homes searched as part of the investigation. Bernucci was suspended after police reportedly found banned products in his house. He remains suspended until his team receive further information about the search.^[382] A day later, the same newspaper revealed more details of the investigation, claiming that 16 of the teams riders and staff had been placed under formal investigation for doping related offences. Amongst the names mentioned by the newspaper are current and former Lampre riders, including Francesco Gavazzi, Damiano Cunego, Alessandro Ballan, and Mauro Santambrogio (Both now at BMC Racing Team). Team manager Saronni, directeur sportifs Fabrizio Bontempi and Maurizio Piovani, current coach Sergio Gelati, and former Lampre doctor Dr Andrea Andreazzoli (now at Astana Team were also named.^[383] On 9 April, BMC Racing suspended its riders Ballan and Santambrogio pending the outcome of the police investigation.^[384]

• On 22 April 2010 Swiss Rider Thomas Frei's A sample, taken during the Giro del Trentino, was found to be positive for EPO. He was suspended by his team, BMC Racing Team, pending further investigation and testing of his B sample.^[385]

• Also on 22 April 2010, the UCI announced that Team Radio Shack rider Li Fuyu had tested positive for the banned substance clenbuterol during the Dwars door Vlaanderen on March 23. He has been suspended by his team pending the outcome of the B sample testing.^[386]

• On 28 April, it was announced that Gabriele Bosisio would be suspended from professional cycling for 2 years. He tested positive for EPO in an out-of-competition test in September 2009. He was provisionally suspended by the UCI on October 6, and so his ban will end on 5 October 2011.^[387]

• On 3 May, the UCI announced the names of three riders who had returned irregular blood values in their blood passport. These riders were Franco Pellizotti, Jesus Rosendo Prado and Tadej Valjavec.^[388] On 22 June, the Spanish Cycling Federation cleared Rosendo.^[389] On 30 July, Valjavec was cleared by the Slovenian anti-doping agency.^[390] On 21 October, Pellizotti was also cleared by his own national anti-doping agency.^[391] The UCI is expected to appeal these decisions.

• One day later, on 4 May, it was announced that French rider Mickaël Larpe had tested positive for EPO, ten hours after his house was raided by police.^[392]

• On 27 May, Francesco De Bonis became the first cyclist to be banned on the evidence of his blood passport results. His 2 year suspension will finish in June 2011, 2 years after he was first stopped from racing.^[393]

• On 3 June, it was announced that Pietro Caucchioli had been banned for 2 years on the evidence of his irregular blood passport results, found in June 2009. His ban will finish in June 2011.^[394]

• On 17 June, the UCI announced that Ricardo Serrano had been suspended by the Spanish cycling federation (RFEC) for two years due to CERA having been found in two separate blood samples collected around a year ago. He was also implicated due to abnormal values in his blood passport.^[395]

• On 20 June, media reports told of how Alessandro Petacchi had been notified at the start of the Tour de France that he had been placed under investigation by a prosecutor in Padova. Petacchi is accused of having used PFC (Perfluorocarbon) and human serum albumin.^[396] The accusations stem from phone taps on a doctor from Brescia.^[397]

• On 7 July, it was announced that Niklas Axelsson had been suspended for life following positive analysis of his B-sample for EPO. He had previously been suspended for EPO use in 2001.^[398]

• Three Brazilian riders were sanctioned for adverse findings during the Tour do Rio in July 2010: Jao Paulo de Oliveira (for phentermine) and two for stanazolol: Lucas Onesco and Jair Fernando dos Santos. All three received a two year suspension and loss of results.^[399]

• On 29 July, the UK Anti-doping agency posted the 2 year suspension for cyclist Dan Staite for EPO and ATD found in sample taken at a National B level event.^[400]

• On 8 September, while he was riding the 2010 Vuelta a España, it was announced that Roy Sentjens had failed an out of competition doping control and would be suspended from cycling.^[401] On September 10, Sentjens admitted to having doped with EPO that he had obtained in Barcelona, Spain, and declined to request the testing of his B-sample. He also announced his immediate retirement from professional cycling.^[402]

• On 16 September, a UCI statement was released announcing that Óscar Sevilla had tested positive for the blood expander Hydroxyethyl starch after the final stage of the Vuelta a Colombia, which he had won, on 15 August.He has been provisionally suspended.^[403] On 30 September, it was announced that the Spanish Cycling Federation will let him continue racing until his B-sample is tested.^[404]

• On 29 September, a UCI statement was released announcing that this year's Tour de France winner, Alberto Contador, had tested positive for "a very small concentration" of the banned stimulant clenbuterol, on July 21, one of the race's rest days. He has been provisionally suspended by the UCI.^[405]

• On 30 September, the UCI announced that Xacobeo-Galicia riders Ezequiel Mosquera and David García Dapena had both tested positive for Hydroxyethyl starch on September 16, during the Vuelta a Espana. Mosquera had finished the race in 2nd place, and Dapena finished 11th overall.^[406] On 6 October, it was announced that Garcia Dapena had tested positive for EPO during the race, on 13 September.^[407]

• On 7 October, Joao Benta admitted to doping after having tested positive in July.^[408]

• On 9 October, Alessandro Colo was given a one-year ban by CONI for testing positive for clenbuterol on the last stage of the Vuelta Mexico.^[409]

• On 18 October, two Portuguese riders - Rui Costa and his brother Mario - were announced as having tested positive for the substance Methylhexanamine. The samples were taken during the Portuguese National Championships at the end of June.^[410]Their ban was reduced to 5 months, rather than the standard 2 years, as they were able to satisfy the panel that this was a case of accidental ingestion, via a contaminated supplement.^[411]

http://en.wikipedia.org/wiki/List_of_doping_cases_in_cycling

Here's the rest complete with 419 annotations. That took 30 seconds, any more "proof" you'd like?

This would be astounding if true. The majority of all patients with blood clots are marathon runners? Or just the majority of athletes with DVTs?

Different kind of marathon for this guy: http://www.foxnews.com/health/2011/08/01/xbox-gamer-dies-blood-clot-after-marathon-session/

Aside from a lot of anecdotal evidence, I can't find anything to suggest a link between endurance athletes and increased rates of blood clots.  Perhaps it's just because we seem to pay more attention when people perceived as otherwise healthy suffer from illnesses more associated with unhealthy people?

I don't want to address the doping issue simply out of respect to the rider and the reality it probably had nothing to do with his blood clot.

http://en.wikipedia.org/wiki/Virchow's_triad

Venous disease is a special interest of mine. Compression hose have been shown to be effective in non-ambulatory, bed ridden people but are probably less effective in people who walk. To decrease the risk of blood clots you should stay well hydrated, walk or activate the calf pumping mechanism at least every 2 hours and take an aspirin a day starting at the age of 40.

I think this is a huge reason. I have no idea what the actual statistics are, but I would hazard a guess that the majority of people that suffer from blood clots/heart problems/etc. are usually not considered to be very healthy. It's a bit of a surprise when prominent people in the active community come down with these types of illnesses, but it's probably at a much smaller rate than the general population. That's my wild guess at least.

Geez....Chris is trying to keep the concept that longer endurance races can cause blood clots. By being aware it can happen, can help triathletes perhaps get diagnosed and treated sooner. Also knowing the possible ways to avoid them is helpful information for all of us.

Why bring up all these other points and arguments and dilute the message?

x2

As the OP stated, DVT/PE is a problem that is typically thought to occur in people with hypercoaguability disorders, risk factors (birth control, etc), pregnant women, post op patients and older people who fly...but DVT (and resulting PE) are relatively common in athletes. It is true that doping can result in DVT/PE due to the "sludging" if you will of blood cells, but more common to result in DVT/PE: hemoconcentration due to dehydration, trauma (crashes, collisions, etc), inflammatory injury to blood vessels, etc.

Just a single case study attached if you are interested. Points out reasons why DVT/PE might be missed (mainly due to patients being outside of the general PE/DVT demographic, musculoskeletal pain due to the event itself, etc).

ETA: article too big. Brief abstract. From Journal of Emergency Medicine, April 2010.

"Abstract

Background: Demanding athletic events can contribute multiple risk factors to the development of deep venous thrombosis (DVT) in athletes. Objectives: To discuss risk factors for the development of DVT in athletes participating in athletic events. Case Report: We present the case of a young female athlete who had a DVT, complicated by pulmonary embolism, after participating in a half-Ironman triathlon. Conclusion: Our patient developed a DVT complicated by pulmonary embolism as a result of many factors relating to participation in a triathlon. Demanding athletic events can contribute different risk factors to the development of DVT in athletes. The diagnosis of DVT should be considered in any athlete presenting with leg pain, especially after a strenuous athletic event.