Patient presented to our clinic for follow up on a previous deep venous thrombosis (also known as a DVT). Patient is an endurance athlete and presented originally to the emergency department (ED) when only one of his legs started to swell after a long plane ride. Patient denied any pain at that time or shortness of breath but upon presentation to the ED patient’s leg was evaluated via ultrasound and a clot was discovered. Patient was placed on a medication known as a novel oral anticoagulant (NOAC) which causes the patient’s blood to stop clotting. Overtime on this medication the patient’s clot will dissolve but while on this medication the patient is at increased risk of bleeding.

A DVT is when a clot forms in a vein located in your leg. Your risk for a DVT is increased when you sit for long periods of time (such as on a plane ride). This allows your blood to pool in your legs which can facilitate your body’s natural ability to form clots when you are cut. These clots will become lodged in your vein leading to a backup of blood and will cause swelling of just one leg which can sometimes lead to pain. The medical concern is less for your leg and more for the possibility of a ‘Pulmonary Embolism’ which is when the clot from your leg is pushed into your lungs leading to heart and breathing issues. Based on recent research we are discovering that a DVT is somewhat more difficult to clinically diagnose in an endurance athlete vs a common person. A physician should be on high alert for even minor unilateral swelling of a leg in an endurance athlete and understand the need for further evaluation faster for this particular patient. This is one of many reasons why high achieving sport and exercise patients should consider having a sports medicine physician as part of their medical team.

Amanda L Zaleski, et al. [Performance of wells score to predict deep vein thrombosis and pulmonary embolism in endurance athletes]. Physician and Sportsmedicine. 2017 Nov; 45 (4) : 358-364.