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Miele C, Mennitti C, Gentile A, Veneruso I, Scarano C, Vastola A, La Monica I, Uomo F, Iafusco F, Capasso F, Pero R, D’Argenio V, Lombardo B, Tinto N, Di Micco P, Scudiero O, Frisso G, Mazzaccara C. Thrombosis and Thrombotic Risk in Athletes. J Clin Med 2024; 13:4881. [PMID: 39201023 PMCID: PMC11355105 DOI: 10.3390/jcm13164881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
The hemostatic system is characterized by a delicate balance between pro- and anticoagulant forces, and the smallest alteration can cause serious events such as hemorrhages or thrombosis. Although exercise has been shown to play a protective role in athletes, several factors may increase the risk of developing venous thromboembolism (VTE), including hemoconcentration induced by exertion, immobilization following sports injuries, frequent long-distance flights, dehydration, and the use of oral contraceptives in female athletes. Biomarkers such as D-dimer, Factor VIII, thrombin generation, inflammatory cytokines, and leukocyte count are involved in the diagnosis of deep vein thrombosis (DVT), although their interpretation is complex and may indicate the presence of other conditions such as infections, inflammation, and heart disease. Therefore, the identification of biomarkers with high sensitivity and specificity is needed for the screening and early diagnosis of thromboembolism. Recent evidence about the correlation between the intensity of physical activity and VTE is divergent, whereas the repeated gestures in sports such as baseball, hockey, volleyball, swimming, wrestling, or, on the other hand, soccer players, runners, and martial art training represent a risk factor predisposing to the onset of upper and lower DVT. Anticoagulant therapy is the gold standard, reducing the risk of serious complications such as pulmonary embolism. The aim of this review is to provide a general overview about the interplay between physical exercise and the risk of thromboembolism in athletes, focusing on the main causes of thrombosis in professional athletes and underlying the need to identify new markers and therapies that can represent a valid tool for safeguarding the athlete's health.
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Affiliation(s)
- Ciro Miele
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- UOC Laboratory Medicine, Haematology and Laboratory Haemostasis and Special Investigations, AOU Federico II University of Naples, 80131 Naples, Italy;
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Cristina Mennitti
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Alessandro Gentile
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Iolanda Veneruso
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Carmela Scarano
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Aniello Vastola
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Ilaria La Monica
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Fabiana Uomo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
| | - Fernanda Iafusco
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Filomena Capasso
- UOC Laboratory Medicine, Haematology and Laboratory Haemostasis and Special Investigations, AOU Federico II University of Naples, 80131 Naples, Italy;
| | - Raffaela Pero
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
| | - Valeria D’Argenio
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, 00100 Rome, Italy
| | - Barbara Lombardo
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Nadia Tinto
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Pierpaolo Di Micco
- AFO Medicina, P.O. Santa Maria delle Grazie, Pozzuoli, ASL Napoli2 nord, 80076 Naples, Italy
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
- Task Force on Microbiome Studies, University of Naples Federico II, 80100 Naples, Italy
| | - Giulia Frisso
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
| | - Cristina Mazzaccara
- Department of Molecular Medicine and Medical Biotechnologies, Federico II University, Via Sergio Pansini 5, 80131 Napoli, Italy; (C.M.); (C.M.); (A.G.); (I.V.); (C.S.); (A.V.); (F.U.); (R.P.); (B.L.); (N.T.); (G.F.); (C.M.)
- CEINGE-Biotecnologie Avanzate Franco Salvatore, Via G. Salvatore 486, 80145 Napoli, Italy; (I.L.M.); (F.I.); (V.D.)
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Zunarelli P, Lucenteforte G, Miceli M, Stride M, Nanni G, Della Villa F. The Use of Diagnostic Ultrasound in Sports Muscle Injuries in Football (Soccer) Players: State-of-the-art Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hilberg T, Ransmann P, Hagedorn T. Sport and Venous Thromboembolism. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:181-187. [PMID: 34024313 DOI: 10.3238/arztebl.m2021.0021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/13/2020] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND The occurrence of venous thromboembolisms (VTE) in association with sporting activity has been described but not yet systematically explored. The aim of this study was to determine the sites at which VTE occur in athletes, the accompanying features, and the special features of the symptoms and diagnosis, so that physicians can take the findings into consideration. METHODS A search of the literature in the databases PubMed, Web of Science, and Cochrane in accordance with the PRISMA criteria, together with a search of Google Scholar up to 29 February 2020. RESULTS No observational studies were identified. A total of 154 case descriptions were evaluated: 89 on upper-extremity deep vein thrombosis (DVT), 53 on lower-extremity DVT, and 12 on pulmonary embolisms with no evidence of thrombosis. Ninety-five percent of the upper-extremity DVT involved the region of the subclavian/axillary vein. Thoracic outlet syndrome (38%), hereditary thrombophilia/a family history of VTE (16%), intensive training (12%), and the use of oral contraceptives (7%) were identified as accompanying features. The upper-extremity DVT occurred mainly in male strength athletes and ball sports players. The lower-extremity DVT were located in the lower leg/knee (30%), the thigh (19 %), or occurred in combination in the lower leg-to-pelvis region (30 %). The features accompanying lower-extremity DVT were hereditary thrombophilia/a family history of VTE (30%), trauma (25%), immobilization (21%), and the use of oral contraceptives (11%). The lower-extremity DVT were found in endurance sports and ball sports. The symptoms may be obscured by sport-specific symptoms/trauma, and diagnosis is often delayed. Early D-dimer determination is useful and is complemented by diagnostic imaging. CONCLUSION VTE are found in association with sports. The background factors, the sites of VTE, the types of sports involved, and the accompanying features are all important to know. The symptoms may be obscured, and it may be difficult to reach the correct diagnosis. The possible presence of DVT must be borne in mind.
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Affiliation(s)
- Thomas Hilberg
- School of Human and Social Sciences, Department of Sports Medicine, University of Wuppertal
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Tural K, Kara F, Avcı S, Erdoğdu Hİ. CAN COMPLETE BLOOD CELL COUNT PARAMETERS PREDICT DEEP VEIN THROMBOSIS? Acta Clin Croat 2020; 59:661-666. [PMID: 34285436 PMCID: PMC8253064 DOI: 10.20471/acc.2020.59.04.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/19/2018] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to evaluate complete blood cell count parameters including red blood cell indices, white blood cell subtypes, and platelet indices for predicting deep vein thrombosis (DVT). A total of 71 (44 male and 27 female) patients with acute femoral and popliteal DVT diagnosed by doppler ultrasonography during a period of seven years (2011-2017) were included in the study. By matching age and gender, 142 (88 male and 54 female) subjects diagnosed with venous insufficiency in the same time interval were assigned as control group. Data were obtained by reviewing hospital records of the study participants, including clinical and demographic characteristics and complete blood cell parameters. Frequencies of hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic renal failure, and coronary arterial disease were higher in DVT group as compared to non-DVT group (p<0.05). Hemoglobin and lymphocyte values were lower, and red blood cell distribution width, neutrophil, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio higher in DVT group as compared with non-DVT group (p<0.05). There was no significant between-group difference in terms of mean corpuscular volume, platelet, mean platelet volume, mean platelet volume to platelet ratio, and platelet distribution width (p>0.05). Hypertension, hemoglobin, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. We found that hypertension, anemia, neutrophil to lymphocyte ratio, and platelet to lymphocyte ratio were independent risk factors for DVT. In particular, neutrophil to lymphocyte ratio and hemoglobin may be used as novel, inexpensive, and reliable diagnostic tools for DVT.
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Affiliation(s)
| | - Fatih Kara
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Sema Avcı
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
| | - Halil İbrahim Erdoğdu
- 1Kafkas University, Medical Faculty, Department of Cardiovascular Surgery, Kars, Turkey; 2Kafkas University, Medical Faculty, Department of Biochemistry, Kars, Turkey; 3Amasya University, Medical Faculty, Department of Emergency Medicine, Amasya, Turkey; 4Kafkas University, Medical Faculty, Department of Internal Medicine, Kars, Turkey
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Rodríguez-Hernández A, Torné R, Blanco Ibáñez de Opacua A, Brugada-Bellsolà F, Remollo S, Domínguez CJ, Rimbau JM. Amateur Endurance Athletes: At Higher Risk of Suffering Dural Arteriovenous Fistulas? Report of 3 Cases. World Neurosurg 2020; 140:32-36. [PMID: 32437989 DOI: 10.1016/j.wneu.2020.05.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The present study aims to draw attention to the fact that endurance sport could be a risk factor for dural arteriovenous fistula (DAVF) development. DAVFs have been correlated with acquired dural venous sinus anomalies owing to trauma, infection, neoplasia, or other classic risk thrombogenic factors. Here we report 3 cases of intracranial DAVF in young healthy patients who had no known thrombogenic risk factors other than amateur intensive sports practice. CASE DESCRIPTION Three young healthy individuals not fitting into the classical clinical picture of a DAVF patient presented to our institution. One was a 40-year-old man with an acute subdural hematoma secondary to an ethmoidal DAVF. Another 41-year-old man presented with a cerebellar hematoma due to a tentorial DAVF. A third 41-year-old man presented with numbness of his right arm in relationship to a superior sagittal sinus DAVF. None of them had a relevant medical history. All the usual thrombogenic risk factors for DAVF development were ruled out. Interestingly, the 3 patients had outstanding training and practice routines for endurance sports. CONCLUSIONS Dehydration, microfractures, muscular contractures, low heart rate, long distance travel, and high altitudes are all well documented thrombogenic risk factors affecting endurance sports amateur athletes and might represent a plausible mechanism for the development of DAVF. Despite its limitations, to our knowledge, this is the first work suggesting a possible link between such sport practice and DAVF development. Further prospective research from larger dedicated vascular centers might shed further light on this hypothetic but intriguing link.
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Affiliation(s)
- Ana Rodríguez-Hernández
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain.
| | - Ramon Torné
- Department of Neurological Surgery, Clinic University Hospital, Barcelona, Spain
| | | | - Ferran Brugada-Bellsolà
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Sebastián Remollo
- Department of Neuroscience, Interventional Neuroradiology Unit, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Carlos J Domínguez
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - Jordi M Rimbau
- Department of Neurological Surgery, Germans Trias i Pujol University Hospital, Badalona, Spain
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Romano S, Salustri E, Robles AG, Calò L, Penco M, Sciarra L. Non-vitamin K antagonist oral anticoagulants and sport. Minerva Cardioangiol 2020; 68:98-109. [PMID: 32429628 DOI: 10.23736/s0026-4725.20.05177-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Physical activity is worldwide recommended for its benefits on cardiovascular system. There is an increasing number of people of all ages that approach sport activity both as leisure time physical activity and as competitive sport. It is always more frequent the request even from older subjects and cardiac patients to be allowed to practice physical activity. Some problems could arise when these subjects present or develop pathologic conditions that require specific pharmacological treatment, in particular an anticoagulation therapy. This review focalizes on the management of oral anticoagulant therapy (OAT) in patients practicing sport activity, especially due to atrial fibrillation and deep vein thrombosis, which represent two highly prevalent conditions, particularly with increasing age. Official recommendations in this field may appear limiting for patients, forbidding in the majority of cases sports at risk of trauma and consequent bleeding. These recommendations still resent the heritage of the "traditional" management of OAT, mainly represented by vitamin-K antagonists (VKAs). The non-vitamin K antagonist oral anticoagulants, with their more favorable pharmacokinetic-pharmacodynamic profile compare to VKAs, may now represent an opportunity to modify the approach to sport activity in patients with an indication to OAT. This review of the literature deals with possible strategies to overcome the present limitations for OAT subjects willing to pursue a healthy lifestyle, that include sport activity, minimizing at the same time their risk of bleeding.
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Affiliation(s)
- Silvio Romano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Elisa Salustri
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy -
| | - Antonio G Robles
- Department of Cardiology, Casilino Polyclinic Hospital, Rome, Italy
| | - Leonardo Calò
- Department of Cardiology, Casilino Polyclinic Hospital, Rome, Italy
| | - Maria Penco
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Luigi Sciarra
- Department of Cardiology, Casilino Polyclinic Hospital, Rome, Italy
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Hemsing AL, Reikvam H. Mondor’s disease after extensive training with Nordic walking. Oxf Med Case Reports 2019; 2019:omz075. [PMID: 31772743 PMCID: PMC6735834 DOI: 10.1093/omcr/omz075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 04/06/2019] [Accepted: 07/06/2019] [Indexed: 12/01/2022] Open
Abstract
We here present a case of a 59-year-old man with Mondor’s disease, thrombophlebitis of the superficial veins of the anterior chest wall. This occurred after the patient had initiated extensive training with walking poles, Nordic walking, probably predisposing to the thrombosis. Underlying disease was ruled out, and the treatment was symptomatic. Physicians should be aware of this condition in patients performing extensive upper body workout.
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Affiliation(s)
- Anette Lodvir Hemsing
- Section of Hematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Håkon Reikvam
- Section of Hematology, Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, N-5021 Bergen, Norway
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Overview of venous pathology related to repetitive vascular trauma in athletes. J Vasc Surg Venous Lymphat Disord 2019; 7:756-762. [PMID: 31231058 DOI: 10.1016/j.jvsv.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity. OBJECTIVE This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors. RESULTS Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression. CONCLUSIONS Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
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Traumatic posterior tibial artery occlusion in a soccer player: A case report. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:153-156. [PMID: 32082726 DOI: 10.5606/tgkdc.dergisi.2018.14719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 07/05/2017] [Indexed: 11/21/2022]
Abstract
A 24-year-old male professional soccer player sustained a right ankle contusion due to blunt kick toward the medial malleolus level during a soccer game. He stopped playing due to pain, coldness, and paresthesia on his right foot. Computed tomography angiography revealed a 4.5 cm occlusion on the posterior tibial artery at the right ankle level of which the distal segment was filled with collateral arteries. After the diagnosis of the traumatic occlusion, the patient underwent angiography for recanalization with thrombolysis in an external center, which was unsuccessful. Crural artery injuries after blunt sport traumas are very rare. In knee and ankle traumas with ischemic symptoms, vascular injuries should be excluded with prompt examination.
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Zaleski AL, Taylor BA, Pescatello LS, Thompson PD, Denegar C. Performance of wells score to predict deep vein thrombosis and pulmonary embolism in endurance athletes. PHYSICIAN SPORTSMED 2017; 45:358-364. [PMID: 28707499 DOI: 10.1080/00913847.2017.1355210] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION There are an increasing number of reports describing deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in otherwise healthy endurance athletes. The Wells score is the most commonly used clinical prediction rule to diagnose DVT/PE in clinical populations. However, the Wells score may have limited utility for recognition of DVT/PE in athletes, contributing to missed or delayed diagnosis. OBJECTIVE We performed an analysis of the ability of the Wells score to identify DVT/PE events in athletes through a review of published case reports. METHODS A systematic search of the literature yielded 11 case reports. RESULTS The Wells score had a 100% failure rate in identifying athletes with DVT (0/6) and PE (0/5), resulting in a delayed diagnosis for DVT of 20 ± 14 days. Retrospectively removing 'differential diagnosis' from the clinical prediction rule for DVT changed the Wells score median from 0 (range: -1 to 0) to 2 (range: 1 to 2); the threshold for predicting DVT as 'likely'. There were limited clinical characteristics captured in the Wells score for PE that were applicable to athletes, highlighting the need for reappraisal. Although the Wells score failed to accurately triage athletes with known DVT and/or PE, the addition of a D-dimer value (mean: 1566 ± 758ng/dL) to the Wells score correctly identified 9/9 athletes. CONCLUSIONS The Wells score had a 100% failure rate for triaging athletes with known DVT/PE. When performed, D-dimer adequately facilitated the additional diagnostic testing required for a timely diagnosis of DVT/PE in athletes. Improving awareness of an atypical presentation of thrombotic events in athletes may reduce the widespread underestimation of DVT/PE among athletes and facilitate the additional testing required for a timely diagnosis.
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Affiliation(s)
- Amanda L Zaleski
- a Department of Kinesiology , University of Connecticut , Storrs , CT , USA.,b Henry Low Heart Center, Department of Cardiology , Hartford Hospital , Hartford , CT , USA
| | - Beth A Taylor
- a Department of Kinesiology , University of Connecticut , Storrs , CT , USA.,b Henry Low Heart Center, Department of Cardiology , Hartford Hospital , Hartford , CT , USA
| | - Linda S Pescatello
- a Department of Kinesiology , University of Connecticut , Storrs , CT , USA
| | - Paul D Thompson
- b Henry Low Heart Center, Department of Cardiology , Hartford Hospital , Hartford , CT , USA
| | - Craig Denegar
- a Department of Kinesiology , University of Connecticut , Storrs , CT , USA
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Kupchak BR, Kraemer WJ, Hooper DR, Saenz C, Dulkis LL, Secola PJ, Brown LE, Galpin AJ, Coburn JW, DuPont WH, Caldwell LK, Volek JS, Maresh CM. The effects of a transcontinental flight on markers of coagulation and fibrinolysis in healthy men after vigorous physical activity. Chronobiol Int 2016; 34:148-161. [DOI: 10.1080/07420528.2016.1247851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Brian R. Kupchak
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - William J. Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - David R. Hooper
- Department of Health Sciences, Armstrong State University, Savannah, GA, USA
| | - Cathy Saenz
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Lexie L. Dulkis
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Paul J. Secola
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Lee E. Brown
- Department of Kinesiology, California State University-Fullerton, Fullerton, CA, USA
| | - Andrew J. Galpin
- Department of Kinesiology, California State University-Fullerton, Fullerton, CA, USA
| | - Jared W. Coburn
- Department of Kinesiology, California State University-Fullerton, Fullerton, CA, USA
| | - William H. DuPont
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Lydia K. Caldwell
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Jeff S. Volek
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
| | - Carl M. Maresh
- Department of Human Sciences, The Ohio State University, Columbus, OH, USA
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Shulman RM, Buchan C, Bleakney RR, White LM. Low prevalence of unexpected popliteal DVT detected on routine MRI assessment of the knee. Clin Imaging 2015; 40:79-85. [PMID: 26603091 DOI: 10.1016/j.clinimag.2015.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 09/03/2015] [Accepted: 09/10/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to document the appearance and determine the prevalence of findings suspicious for popliteal vein thrombosis on magnetic resonance (MR) assessment of the knee joint. METHODS A total of 2888 MR examinations were retrospectively reviewed and classified as illustrating either normal appearing popliteal vein or findings suspicious for popliteal vein thrombosis. RESULTS A total of 2879 MR studies were assessed as having a normal appearing popliteal vein. Nine studies illustrated findings suspicious for popliteal vein thrombosis. CONCLUSION Although the prevalence of MR findings is low (0.3%), our findings reiterate the need to interrogate the popliteal vein for evidence of thrombosis.
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Affiliation(s)
- Ryan M Shulman
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging. Current address; Gold Coast University Hospital, Cnr Parklands Drive and Olsen Avenue, Southport, Queensland, 4215, Australia.
| | - Craig Buchan
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging; Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging. Current address; Gold Coast University Hospital, Cnr Parklands Drive and Olsen Avenue, Southport, Queensland, 4215, Australia.
| | - Robert R Bleakney
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging.
| | - Lawrence M White
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital, and Women's College Hospital. 600 University Avenue, Toronto, ON, Canada, M5G 1X5. University of Toronto, Department of Medical Imaging.
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Casals M, Martínez JA, Caylà JA, Martín V. Do Basketball Players Have a High Risk of Pulmonary Embolism? A Scoping Review. Med Sci Sports Exerc 2015; 48:466-71. [PMID: 26440133 DOI: 10.1249/mss.0000000000000780] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Pulmonary embolism (PE) is a serious preventable disease that requires urgent care. In recent years, there have been several reports in the media about basketball players experiencing PE. The aim of the present study was to assess whether there is a need for in-depth studies to determine whether basketball players constitute a group particularly at risk of PE and to describe some hypotheses to be investigated. METHODS We reviewed original articles about PE among professional and amateur basketball players in the scientific literature (PubMed) and the Internet (Google search) for the seasons 2010-2011 to 2014-2015, both of which were included. We used search strategies that included some combination of PE-related terms. Rates of PE were calculated and were compared with those obtained from other studies. RESULTS Of the 15 cases detected, the majority were men (66.7%), mean ages being 28.8 yr among males and 20.4 yr among females. We focused on six cases which, were detected among National Basketball Association and Asociación de Clubes de Baloncesto basketball players, resulting in an average incidence of 1.27 and 2.06 cases per 1000 players per year in the National Basketball Association and Asociación de Clubes de Baloncesto, respectively. This incidence is much higher than that observed in general population studies for the same age group. CONCLUSIONS Basketball players seem to have a higher risk of PE than their peers from the general population. More studies are needed to confirm these findings and identify factors predisposing them to PE to contribute to its prevention.
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Affiliation(s)
- Martí Casals
- 1Research Centre Network for Epidemiology and Public Health (CIBER Epidemiología y Salud Pública), Barcelona, SPAIN; 2Epidemiology Service, Public Health Agency of Barcelona, Barcelona, SPAIN; 3Biostatistic Unit, International University of Catalonia, Barcelona, SPAIN; 4Department of Business Economics, Faculty of Business Science, Polytechnic University of Cartagena, Murcia, SPAIN; and 5Area of Preventive Medicine and Public Health, University of León, León, SPAIN
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Jackson SS, O'Brien MJ. Case report: upper extremity deep venous thrombosis in a 19-year-old baseball player. PHYSICIAN SPORTSMED 2014; 42:163-7. [PMID: 25244713 DOI: 10.3810/psm.2014.05.2068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This report describes a case of a collegiate baseball player who presented with 3 weeks of worsening right shoulder pain and mild swelling and faint discoloration of the right arm and hand. He was found to have a nonocclusive clot on his brachial vein and was treated with anticoagulants. This was his second lifetime thrombosis. A hematologic workup revealed no evidence of a hereditary origin, and thrombosis was believed to be related to recent exertion (baseball throwing). Upper extremity deep vein thromboses are extremely uncommon. However, because they can have potentially life-threatening consequences, deep vein thromboses must be on the differential for any athlete who presents with increased pain, swelling, or discoloration of an extremity.
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Affiliation(s)
- Sarah S. Jackson
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA
| | - Michael J. O'Brien
- Division of Sports Medicine, Boston Children's Hospital, Boston MA
- The Micheli Center for Sports Injury Prevention, Waltham, MA
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15
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Acute pulmonary thromboembolism from deep vein thrombosis induced by trauma to the popliteal vein with a tennis racket. J Cardiol Cases 2014; 9:162-164. [DOI: 10.1016/j.jccase.2014.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 12/23/2013] [Accepted: 01/06/2014] [Indexed: 11/21/2022] Open
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Hosseini M, Hedjazi A, Bahrani M. Missed opportunities for diagnosis of post-traumatic thrombosis: a case series and literature review. J Forensic Sci 2014; 59:1417-9. [PMID: 24593035 DOI: 10.1111/1556-4029.12453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 07/07/2013] [Accepted: 07/28/2013] [Indexed: 11/26/2022]
Abstract
Thrombosis is caused by abnormalities in the composition of the blood, the quality of the vessel wall, and the nature of the blood flow. Herein, we present four cases of fatal thrombus formation after a trauma, which were missed at clinical diagnosis as the symptoms were misinterpreted. We stress that a blunt trauma can be fatal because of its direct and indirect kinetic energy effects at the subacute phase. This report highlights the importance of considering thrombosis in the diagnosis of closed trauma, which is usually missed because of lack of awareness for early diagnosis and treatment or is detected too late for any therapeutic intervention, which can result in avoidable morbidity and mortality.
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Affiliation(s)
- Marzieh Hosseini
- Department of Pathology Lab, Fars Legal Medicine Research Center, Tehran, Iran
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Soo Hoo GW. Overview and assessment of risk factors for pulmonary embolism. Expert Rev Respir Med 2013; 7:171-91. [PMID: 23547993 DOI: 10.1586/ers.13.7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Pulmonary embolism is one of the most common undiagnosed conditions affecting hospitalized patients. There are a plethora of risk factors for venous thromboembolism and pulmonary emboli. These factors are grouped under the broad triad of hypercoagulability, stasis and injury to provide a framework for understanding. Important risk factors include inherited thrombophilia, age, malignancy and estrogens. These risk factors are reviewed in detail and several risk assessment models are reviewed. These risk assessment models help identify those at risk for disease and therefore candidates for thromboprophylaxis. Diagnosis can be difficult and is aided by clinical decision rules that incorporate clinical scores that define the likelihood of pulmonary embolism. These are important considerations, not only for diagnostic purposes, but also to minimize excessive use of imaging, which increases exposure to and risks associated with radiation. A healthy index of suspicion is often the key to diagnosis.
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Affiliation(s)
- Guy W Soo Hoo
- Pulmonary and Critical Care Section, West Los Angeles Veterans Affairs Healthcare Center, Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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18
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Botto N, Pasanisi E, Chubuchny V, Andreassi MG. Deep venous thromboembolism after a trauma in a football player double heterozygous for factor V Leiden and prothrombin G20210A mutation: The role of genetic testing in sport. J Cardiol Cases 2012; 6:e133-e136. [PMID: 30546722 DOI: 10.1016/j.jccase.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/12/2012] [Accepted: 07/05/2012] [Indexed: 11/16/2022] Open
Abstract
Traumatic vascular injuries to the lower limb are frequent in athletes, particularly in sports characterized by high-speed collisions. However, the diagnosis is not always straightforward, for the lack of clearly visible abnormalities without provocative testing or appropriate imaging. The failure of an early diagnosis can lead to devastating consequences. In these subjects, it may be useful to investigate the personal susceptibility to thrombotic events such as the presence of a hereditary hypercoagulable state. We experienced a case of a soccer player with progressive swelling and severe pain of the calf after a trauma during a football match 3 days previously, who came to our hospital for suspected deep vein thrombosis, confirmed by echo-Doppler ultrasound. A thrombophilia screening detected a double heterozygosity for factor V Leiden and prothrombin G20210A mutation in the presence of a strong family history for thromboembolism. Immediate treatment with elastic stocking compression and enoxaparin was started. The patient was discharged on warfarin therapy maintained for six months, with the warning to avoid trauma activities during anticoagulation. Thrombotic genetic testing in athletes who experience episodes of deep vein thrombosis might offer important opportunities for patient management, such as prolonged anticoagulant therapy or avoidance of risk factors such as trauma-related sports.
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Affiliation(s)
- Nicoletta Botto
- Genetics Research Unit, Fondazione Gabriele Monasterio CNR-Regione Toscana, G. Pasquinucci Hospital, Via Aurelia Sud-Montepepe, 54100 Massa, Italy
| | - Emilio Pasanisi
- Cardiology Department, Fondazione Gabriele Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vlad Chubuchny
- Cardiology Department, Fondazione Gabriele Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria Grazia Andreassi
- Genetics Research Unit, Fondazione Gabriele Monasterio CNR-Regione Toscana, G. Pasquinucci Hospital, Via Aurelia Sud-Montepepe, 54100 Massa, Italy.,CNR-Institute of Clinical Physiology, Pisa, Italy
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Deep Venous Thromboembolism in a Triathlete. J Emerg Med 2010; 38:351-3. [DOI: 10.1016/j.jemermed.2008.07.030] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 06/05/2008] [Accepted: 07/12/2008] [Indexed: 11/18/2022]
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Abstract
Thrombophilia refers to the increased tendency to form blood clots (thrombosis), which is a major cause of morbidity and mortality. Thrombosis is associated with various chronic conditions such as cancer, diabetes, renal disorders, and cardiovascular disease. The incidence and associated complications of thrombosis are likely to increase significantly in the next few decades because of aging populations. Regular exercise has been proposed to decrease the risk of developing thrombosis, although there are inconsistent data from studies investigating its effects, with reports of both increased and decreased thrombotic risk across a variety of subject cohorts. Confounders such as age, gender, hormonal variations, physical activity, underlying disease and treatment, and body composition also contribute to the difficulty in assessing and defining the precise effects of exercise in preventing thrombotic events. However, there is evidence suggesting that physical activity is beneficial for reducing thrombotic risk in younger individuals and those with chronic conditions. This article aims to summarize the known risk factors for thrombosis and briefly review the benefits of exercise in the general population. Furthermore, this article highlights the additional factors in a cohort of individuals that would (at first) appear unlikely to be at risk of thrombosis--elite athletes.
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Affiliation(s)
- Murray Adams
- School of Human Life Sciences, University of Tasmania, Tasmania 7250, Australia.
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Thompson TL, Robinson AK, Gilbert C. Deep vein thrombosis of the lower extremity in a football player: a case report. Clin J Sport Med 2006; 16:372-4. [PMID: 16858228 DOI: 10.1097/00042752-200607000-00019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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