Keywords: triathlon; marathon; deep venous thrombosis; pulmonary embolism; athlete
Tour de France rider suffers blood clot, be aware
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2011-08-02 12:28 PM |
Subject: Tour de France rider suffers blood clot, be aware Chris Horner got a pulmonary embolism following his Tour de France crash http://www.cascadegranfondo.com/blog/what-i-did-my-summer-vacation%E2%80%A6 You might think this is a Peloton forum or Health or Cup of Joe forum topic, but anyone doing longer endurance events needs to be aware of the risks. It's not just out of shape people, or people on long flights, or women on birth control. In fact one study concluded that the majority of people getting blood clots were marathoners. Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise Edited by ChrisM 2011-08-02 12:31 PM |
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2011-08-02 12:44 PM in reply to: #3625595 |
Expert 1379 Woodland, California | Subject: RE: Tour de France rider suffers blood clot, be aware Thanks for posting this. I have seen many posts from you on this topic, and it has helped keep the issue in my mind so I'm more aware of the risk factors and symptoms. On the long drive home from my 1/2 IM this past weekend I made sure to stay hydrated and keep my legs moving as much as possible! |
2011-08-02 12:51 PM in reply to: #3625595 |
Master 5557 , California | Subject: RE: Tour de France rider suffers blood clot, be aware Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise Risk factors like blood doping? I'm not at all surprised to see this happen to a Tour rider. |
2011-08-02 12:52 PM in reply to: #3625654 |
Champion 7136 Knoxville area | Subject: RE: Tour de France rider suffers blood clot, be aware spudone - 2011-08-02 1:51 PM Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise 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. |
2011-08-02 1:03 PM in reply to: #3625659 |
Master 5557 , California | Subject: RE: Tour de France rider suffers blood clot, be aware Leegoocrap - 2011-08-02 10:52 AM spudone - 2011-08-02 1:51 PM Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise 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 |
2011-08-02 1:08 PM in reply to: #3625692 |
Pro 4675 Wisconsin near the Twin Cities metro | Subject: RE: Tour de France rider suffers blood clot, be aware spudone - 2011-08-02 1:03 PM Leegoocrap - 2011-08-02 10:52 AM spudone - 2011-08-02 1:51 PM Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise 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 so.....ummmm.....we should forget that you were basically implying that Chris Horner is a doper??????????? |
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2011-08-02 1:15 PM in reply to: #3625595 |
Subject: ... This user's post has been ignored. |
2011-08-02 1:20 PM in reply to: #3625700 |
Master 5557 , California | Subject: RE: Tour de France rider suffers blood clot, be aware Birkierunner - 2011-08-02 11:08 AM spudone - 2011-08-02 1:03 PM Leegoocrap - 2011-08-02 10:52 AM spudone - 2011-08-02 1:51 PM Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise 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 so.....ummmm.....we should forget that you were basically implying that Chris Horner is a doper??????????? I implied that Tour riders, are generally not clean and no, you don't have to forget I said it. |
2011-08-02 1:42 PM in reply to: #3625595 |
Veteran 480 | Subject: RE: Tour de France rider suffers blood clot, be aware 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. |
2011-08-02 2:00 PM in reply to: #3625717 |
Champion 7136 Knoxville area | Subject: RE: Tour de France rider suffers blood clot, be aware tkos - 2011-08-02 2:15 PM And just to be aware that while things liek EPO certainly can't help in these cases, the UCI put out a list of suspected riders scored from 0 - 10 (well leaked out), and Horner was listed as a zero with a handful of other guys. I will say... that list looked like a joke, and I like almost every guy that scored a 0. |
2011-08-02 2:05 PM in reply to: #3625729 |
Veteran 362 CT | Subject: RE: Tour de France rider suffers blood clot, be aware spudone - 2011-08-02 2:20 PM Birkierunner - 2011-08-02 11:08 AM spudone - 2011-08-02 1:03 PM Leegoocrap - 2011-08-02 10:52 AM spudone - 2011-08-02 1:51 PM Dehydration, micro damage to muscles, low heart rate, immobilization from injury, or a long car ride home, are all risk factors. Know the risk factors and avoid them if at all possible and manage them otherwise 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 so.....ummmm.....we should forget that you were basically implying that Chris Horner is a doper??????????? I implied that Tour riders, are generally not clean and no, you don't have to forget I said it.
I always love the generic doping accusations with nothing to back it up |
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2011-08-02 2:05 PM in reply to: #3625729 |
Champion 9407 Montague Gold Mines, Nova Scotia | Subject: RE: Tour de France rider suffers blood clot, be aware spudone - 2011-08-02 3:20 PM I implied that Tour riders, are generally not clean and no, you don't have to forget I said it. How would you analyze the cleanliness of riders at this year's events? Shane |
2011-08-02 3:40 PM in reply to: #3625595 |
Veteran 371 | Subject: RE: Tour de France rider suffers blood clot, be aware So, sorry if this is a simple question, but what can one do to minimize the risk? Stay hydrated. Don't sit too long. Anything else? |
2011-08-02 5:08 PM in reply to: #3625811 |
Extreme Veteran 662 Sunny San Diego | Subject: RE: Tour de France rider suffers blood clot, be aware
I always love the generic doping accusations with nothing to back it up *Facepalm* |
2011-08-02 5:09 PM in reply to: #3626036 |
Subject: RE: Tour de France rider suffers blood clot, be aware ersmith29 - 2011-08-02 1:40 PM So, sorry if this is a simple question, but what can one do to minimize the risk? Stay hydrated. Don't sit too long. Anything else? 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:
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2011-08-02 5:36 PM in reply to: #3626193 |
Veteran 244 Ohio | Subject: RE: Tour de France rider suffers blood clot, be aware Anyway, those are the two main ones, but there are others, including potentially the use of compression gear (which is debatable on recent studies Curious as to why compression gear is debatable. Don't they use compression socks, etc in hospitals for this reason? |
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2011-08-02 5:40 PM in reply to: #3626238 |
Subject: RE: Tour de France rider suffers blood clot, be aware buck1400 - 2011-08-02 3:36 PM Anyway, those are the two main ones, but there are others, including potentially the use of compression gear (which is debatable on recent studies 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 |
2011-08-02 5:42 PM in reply to: #3625811 |
Expert 1139 Austin | Subject: RE: Tour de France rider suffers blood clot, be aware ctbrian - 2011-08-02 2:05 PM I always love the generic doping accusations with nothing to back it up
Here's 2010 2010
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?
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2011-08-02 9:21 PM in reply to: #3625595 |
Veteran 459 Indiana | Subject: RE: Tour de France rider suffers blood clot, be aware ChrisM - 2011-08-02 1:28 PM In fact one study concluded that the majority of people getting blood clots were marathoners. 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? |
2011-08-02 10:05 PM in reply to: #3626463 |
Extreme Veteran 845 Springfield, OH | Subject: RE: Tour de France rider suffers blood clot, be aware alath - 2011-08-02 10:21 PM ChrisM - 2011-08-02 1:28 PM In fact one study concluded that the majority of people getting blood clots were marathoners. 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? |
2011-08-02 10:07 PM in reply to: #3625595 |
Master 2094 | Subject: RE: Tour de France rider suffers blood clot, be aware 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. |
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2011-08-02 11:53 PM in reply to: #3626518 |
Expert 1139 Austin | Subject: RE: Tour de France rider suffers blood clot, be aware apicek - 2011-08-02 10:05 PM 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 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. |
2011-08-03 12:31 AM in reply to: #3625595 |
Champion 19812 MA | Subject: RE: Tour de France rider suffers blood clot, be aware 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?
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2011-08-03 6:58 AM in reply to: #3626602 |
Champion 6656 | Subject: RE: Tour de France rider suffers blood clot, be aware KathyG - 2011-08-02 11:31 PM 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. "AbstractBackground: 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. Deep venous thrombosis (DVT) is a common diagnosis made in the emergency department (ED). The incidence has been estimated to range anywhere from 40 to 80 cases per 100,000 people annually, and all cases of venous thromboembolism, including pulmonary embolism, affect 1 in 1000 people per year (1). The true incidence of DVT is unknown secondary to inaccuracies of clinical diagnoses as well as the occurrence of many occult thromboses that resolve spontaneously. DVT is a diagnosis that should be considered in young, healthy athletes with symptoms, especially after demanding athletic events, despite the fact that it has rarely been reported ([2], [3] and [4]).Case Report
A 33-year-old female triathlete with no past medical history presented to the ED complaining of 3 weeks of progressively worsening left lower extremity swelling and pain. She finished a half-Ironman triathlon 3 weeks prior. The morning after the race she drove a car about 5 h, stopping twice to walk. Her symptoms began shortly after the car ride. She also noted progressively worsening dyspnea on exertion and lightheadedness, all of which started after the leg symptoms. She was seen by a general practitioner 1 week after her symptoms began and was given a short course of corticosteroids for presumed lung inflammation. She did note mild improvement but, due to concerns regarding persistent leg pain, she obtained a referral to an orthopedist. On follow-up with the orthopedist 1 week later (after 2 weeks of symptoms), she was given a course of celecoxib (Celebrex; Pfizer Inc., New York, NY) and physical therapy. Her symptoms continued to worsen and prompted her to come to the ED. The patient had no significant medical history, including no prior DVT or malignancy. Her current medications included celecoxib and oral contraceptives. She denied smoking and illicit drug use. There was no family history of hypercoagulopathies. On physical examination, her vitals signs were stable and she had an oxygen saturation of 100% on room air. She had a regular heart rate and rhythm and no murmurs, rubs, or gallops were appreciated. The lungs were clear to auscultation bilaterally. The left lower extremity was noted to be diffusely erythematous, warm, swollen, and tender to palpation to just above the knee. Pulses were equal in bilateral lower extremities. The rest of the physical examination was unremarkable. An evaluation for suspected DVT with possible pulmonary embolism was initiated. An electrocardiogram was normal, with a sinus rhythm of 62 beats/min with no signs of right heart strain. Complete blood count, electrolytes, and coagulation studies were unremarkable. A bedside venous duplex ultrasound was done by the vascular surgery technician and was significant for an occlusive DVT in the superficial femoral vein through the popliteal vein, with a non-occlusive DVT in the common femoral vein of the left lower extremity. A computed tomography scan of the chest with contrast was significant for extensive bilateral central pulmonary emboli. She was admitted to the medical service and started on low-molecular-weight heparin and warfarin. She remained in stable condition throughout her hospital stay and the lower extremity swelling improved. She was later discharged on warfarin, and an outpatient hypercoagulability workup was negative. DiscussionDiagnosing deep venous thromboses and their sequelae are an integral part of emergency medicine. Venous thromboembolism occurs in about 1 in 1000 people per year, and 1–5% of those afflicted will die from complications, mainly pulmonary embolism (5). The diagnosis might have eluded the two physicians the patient visited previously because she was a young, healthy patient with few apparent risk factors. Her pain easily could have been attributed to musculoskeletal pain in light of the recently completed vigorous competition. The significance of her lower extremity swelling may not have been appreciated initially. In addition, elite athletes may not exhibit tachycardia from a pulmonary embolism secondary to their propensity to be bradycardic at baseline. Virchow's triad of venous stasis, endothelial injury, and hypercoagulability can help to identify general risk factors for venous thrombosis. Endurance athletes are exposed to many of these factors during prolonged strenuous exercise, particularly a triathlon. Endurance competitions such as triathlons and marathons often expose patients to the risk factors of trauma, including repetitive microtrauma and increased endothelial injury, increasing the risk of thrombosis (6). Dehydration during these events can also lead to hemoconcentration. The relationship of hemoconcentration to thrombotic events is undetermined, but in combination with other factors, it may contribute to an increased risk of DVT in athletes. In many cases, including our patient, these effects are compounded by immobilization after exertion and frequent long distance travel to and from the actual competition (7). Violent effort or prolonged, strenuous exercise causing a DVT is rare but well described in the literature, particularly for the upper extremity. Effort thrombosis of upper extremity vasculature results from microtrauma to the axillo-subclavian vein leading to activation of the coagulation cascade and subsequent DVT formation. This condition is also known as Paget-Schroetter syndrome (6). Similar mechanisms have been reported in case reports concerning the lower extremity ([2], [3] and [4]). An additional factor that may contribute to DVT formation is muscle hypertrophy, leading to compression of venous structures, leading to stasis. Use of hormonal therapy, as in our patient, adds a fourfold increase in risk (6). The role of corticosteroids in the development of DVTs is still somewhat controversial ([8], [9] and [10]). Elite athletes often rest after an event and can be relatively immobilized. The effect of this relative immobilization after competition is compounded by having to travel long distances to competitions, as our patient did. Some studies have shown that the risk of DVT is the same for any prolonged length of travel > 4 h, whether by air, car, bus, or train (7). However, our patient did stop multiple times to walk and stretch, which should have been protective given the relatively short length of time of each driving segment (11 Y.L. Chee and H.G. Watson, Air travel and thrombosis, Br J Haematol 130 (2005), pp. 671–680. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (33)[11] and [12]). ConclusionDeep venous thrombosis can occur in young, healthy athletes presenting with lower extremity pain or swelling after strenuous exertion. This population, especially endurance athletes, is often exposed to multiple different factors leading to venous stasis and endothelial injury, thus increasing their risk for thrombosis. Many may go undiagnosed secondary to expectations of pain and swelling after endurance events. More research needs to be done to determine the incidence of deep venous thrombosis in athletes after demanding events like triathlons."
Edited by mndymond 2011-08-03 7:02 AM |
2011-08-03 7:42 AM in reply to: #3626602 |
Subject: ... This user's post has been ignored. |
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