Deep vein thrombosis in a well-trained masters cyclist, is popliteal vein entrapment syndrome to blame?

J Thromb Thrombolysis. 2019 Feb;47(2):301-304. doi: 10.1007/s11239-018-1796-x.

Abstract

Whilst athletes are the epitome of health, venous thromboembolisms (VTE) including deep vein thrombosis and pulmonary embolism have been demonstrated to occur in well-trained athletes. VTE is frequently misdiagnosed and poorly treated within this population, often resulting in career or life-threatening ramifications. Furthermore, VTE risk rises with increasing age (> 40 years), potentially affecting masters athletes. A 44-year-old well-trained male cyclist volunteered to participate in a research project investigating the influence of exercise on haemostasis in well-trained athletes. The cyclist presented with elevated D-Dimer levels both pre- (2251 ng/mL) and post-exercise (2653 ng/mL). The cyclist reported constant mild-pain in the left mid-calf region, with a cold tingling sensation in their left foot. Diagnosis of DVT was confirmed via a DVT squeeze test and Doppler ultrasound, with the clot located in the left popliteal vein. During the research project, the cyclist was exposed to numerous thrombogenic risk factors including travel, dehydration, prolonged sitting and exercise. The DVT in the popliteal vein may have resulted from repetitive movements associated with cycling. Additionally, hypertrophy of the gastrocnemius muscle may have impinged the vein. When diagnosing DVT within a cycling population, PVES should not be overlooked as a contributing factor.

Keywords: Athletes; Deep vein thrombosis; Doppler ultrasound; Sports related compression.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Bicycling*
  • Factor Xa Inhibitors / administration & dosage
  • Humans
  • Male
  • Muscle Contraction
  • Peripheral Vascular Diseases / complications*
  • Peripheral Vascular Diseases / diagnostic imaging
  • Physical Endurance
  • Popliteal Vein* / diagnostic imaging
  • Risk Factors
  • Rivaroxaban / administration & dosage
  • Syndrome
  • Treatment Outcome
  • Ultrasonography, Doppler
  • Venous Thrombosis / diagnostic imaging
  • Venous Thrombosis / drug therapy
  • Venous Thrombosis / etiology*

Substances

  • Factor Xa Inhibitors
  • Rivaroxaban