Pulmonary Embolism (PE) is a dangerous condition that occurs when a blood clot breaks away from a venous clot from the arms or legs and becomes trapped in the lung, blocking the ability of the lung to receive oxygen. Risk factors for PE include being unable to move enough, having surgery, smoking, a history of deep vein thrombosis (DVT), or having certain conditions like high blood pressure or chronic heart disease.
Most healthy young adults don’t even consider themselves at risk of blood clots and PE. As a healthy athlete, you likely assume you are at a very low risk of this condition as well. When tennis star Serena Williams was diagnosed with DVT, it made headlines, but she is far from the only athlete to suffer from this potentially life-threatening condition. Unfortunately, research indicates that athletes may have a higher-than-expected risk of blood clots and complications.
Understanding PE and DVT
DVT is a condition in which a blood clot forms in a deep vein of the body and limits blood flow. While DVT can happen in the chest or arms, it’s most common in the pelvis and legs. PE is a life-threatening complication of DVT that occurs when one or more clots travel to the lung. In the case of a massive or sub-massive blood clot, this can strain the heart’s ability to pump blood to the lungs and lead to cardiovascular collapse or heart failure.
Pulmonary embolisms can be immediately fatal. DVT and PE are estimated to kill between 60,000 and 100,000 Americans every year with 10-30% dying within one month of diagnosis. In nearly 25% of people with PE, sudden death is the first symptom.
Why Are Athletes at Risk of Blood Clots?
The risk factors for PE and blood clots fall into three main categories: how prone your blood is to developing clots, the smoothness and general health of your blood vessels, and how vigorously your blood flows through your veins.
According to a case report published by Dr. Claire Hull of Swansea University in Wales, endurance athletes are prone to all three of these risk factors.
The findings of the report found that inflammation and dehydration make blood more prone to clots while physical trauma, including muscle strains, can damage the walls of blood vessels. A low resting heart rate and low blood pressure, common among athletes, allows blood to pool during immobility. Blood flow is even further compromised with athletes are taking long flights to competitions.
The report even uncovered what physicians suspect is another factor in PE among athletes: slight muscle tears that occur during exercise may precipitate a blood clot when bacteria already in the body congregates at the injury site.
As an athlete, there can be a number of factors that put you at risk for DVT and PE.
Long Distance Traveling
Top athletes are often required to take long flights to participate in competitions. Sitting in a cramped plane seat for 4 or more hours increases the risk of DVT and inactivity before or after a competition can also contribute to the problem.
High-performance athletes can easily become dehydrated and sweat excessively, despite drinking plenty of water and sports drinks. Dehydration reduces plasma levels while increasing the stickiness and thickness of blood, making clots more likely to develop.
Low Heart Rate
Athletes have lower-than-average blood pressure and heart rates, both of which can contribute to blood pooling and clotting.
Female athletes sometimes use hormone contraceptives to avoid menstruating during competitions. Birth control medication that contains estrogen only or estrogen and progestin increases the risk of blood clots.
Even minor muscle strains, let alone fractures, are believed to increase the risk of DVT and PE. More serious injuries that reduce mobility can allow blood to pool in the legs and contribute to clotting.
How Athletes Can Reduce the Risk
A series of guidelines were published in the Circulation journal to raise awareness of blood clots and help endurance athletes lower their risk. The steps you can take as an athlete to lower your risk of DVT and PE are the same as those for the general population, although there are a few additional awareness issues to consider:
- Be extremely vigilant to thirst. Dehydration can be an important risk factor of blood clots by making your blood more likely to clot. Drink plenty of water and electrolytes before and after you train and avoid excessive alcohol and caffeinated drinks.
- Wear compression socks during long-distance air travel.
- It’s also recommended that you get up and walk on the plane as often as you can to avoid sitting in a cramped position for too long. Don’t cross your legs at the ankle or knee during air travel.
- A daily aspirin regimen may be advisable, but it’s important to talk to your doctor first.
Not all sports and activities are considered high risk. Low-risk activities include power walking, swimming, and controlled conditioning exercises in a gym. High-risk activities include cycling, baseball, soccer, boxing, and marathon running.
After a DVT diagnosis, it’s recommended that you wait to train for at least 1 month until the clot has adhered to the wall of the blood vessel to lower the risk of PE.
Know the Warning Signs
Finally, it’s important that you recognize the symptoms of deep vein thrombosis and pulmonary embolism as soon as possible.
Signs of DVT include:
- Swelling in one or both legs, usually at the ankle or calf
- Leg tenderness, pain, or a sensation of chronic cramping that doesn’t get better with painkillers, ice, and stretching. Inactivity can make this pain worse while activity can make it better.
- Leg is warm to the touch
- Unexplained swelling of the upper arm or neck
- Blue or red skin discoloration that is most apparent during a hot bath or shower
Symptoms of PE include:
- Rapid heart rate
- Cramping in the side or chest
- Painful breathing
- Chest pain that radiates to the shoulder
- Sudden shortness of breath
- Unexplained cough that may come with bloody mucus
- Lightheadedness or dizziness