|
1
|
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.
Collapse
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.)
| |
Collapse
|
|
2
|
LE Douairon Lahaye S, LE Cunuder A, Lachard T, Menard V, Lhuissier F, Dupont AC, Wurtz AS, Marblé C, Carré F, Schnell F. Cardiac Events in World-Class Athletes: An Internet-Based Study. Med Sci Sports Exerc 2022; 54:2064-2072. [PMID: 35881931 DOI: 10.1249/mss.0000000000003001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed at assessing the prevalence of adverse cardiac events, as identified in the media, in world-class athletes according to their sex and sports discipline. METHODS All female and male athletes from 30 individual Olympic sports who ranked in the international yearly top 10 between 2006 and 2018 were included. The name of each of them was associated in a Google search with selected key terms related to heart disease and/or acute cardiac events after their inclusion date. Global and sex-specific adverse cardiac event hazard function λ were calculated for each sport. Global and sex-specific prevalences of cardiac events were calculated, then compared (Fisher's exact test) between all sports. RESULTS From the 2471 athletes included, 15 cases of cardiac events (prevalence of 0.61%) were reported; 2 sudden cardiac deaths (0.08%) occurred in male athletes. The other events were related to arrhythmic events ( n = 13), mainly supraventricular arrhythmias ( n = 9). All surviving athletes were able to continue their career, mostly after ablation procedure. Male endurance athletes accounted for seven events, among which three events occurred among short-distance triathletes. Events among women were comparatively rare ( n = 4), and all were observed among short-distance triathletes. CONCLUSIONS A relatively unexpected high prevalence of cardiac events in endurance elite athletes was observed as compared with other sports, mainly, in short-distance male and female triathletes. This raises the question of particular cardiovascular constraints in this discipline and underlines the urge of international longitudinal follow-up studies in these kinds of athletes.
Collapse
Affiliation(s)
| | - Anne LE Cunuder
- Institute of Sport Sciences, University of Lausanne, Lausanne, SWITZERLAND
| | - Thibault Lachard
- CHU Rennes, Department of Sports Medicine, University Hospital of Rennes, Rennes, FRANCE
| | - Vincent Menard
- M2S Laboratory, Ecole Normale Supérieure Rennes, University of Rennes 2, Rennes, FRANCE
| | | | | | | | | | | | | |
Collapse
|
|
4
|
Chill NM, Monseau AJ, Balcik BJ, Sikora RD, Oppenlander K. Case Report: A Near Miss of Pulmonary Embolism in a Division 1 Collegiate Basketball Player. Clin Pract Cases Emerg Med 2020; 4:551-554. [PMID: 33217270 PMCID: PMC7676789 DOI: 10.5811/cpcem.2020.7.47887] [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: 04/25/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The clinical presentation of pulmonary embolism (PE) is often associated with classic vital instability such as tachycardia, hypoxia, and tachypnea. This critical diagnosis is often less likely if a patient is negative by Pulmonary Embolism Rule-Out Criteria (PERC) standards with a low pre-test probability of disease. Caution must be used when evaluating elite athletes with the PERC rule due to low resting heart rate and certain risk factors, which are inherent to athletics. CASE REPORT We report the case of a 20-year-old male Division 1 collegiate athlete with pleuritic chest pain diagnosed with PE despite being PERC negative. His presenting heart rate (HR) of 79 beats per minute was correctly determined to be tachycardic relative to his resting HR of 47-60 beats per minute. Despite his PERC negative status, PE was found after an elevated D-dimer and subsequent computed tomography angiography. CONCLUSION Special consideration should be used when evaluating elite athletes for PE, as their resting physiology may differ from the general population. Additionally, certain risk factors for thromboembolic disease are inherent in competitive athletics and should be considered during an initial risk assessment. The presented patient was successfully treated with oral anticoagulation for three months and was able to return to play.
Collapse
Affiliation(s)
- Nicholas M Chill
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Aaron J Monseau
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Brenden J Balcik
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Rosanna D Sikora
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| | - Kathryn Oppenlander
- West Virginia University School of Medicine, Department of Emergency Medicine, Morgantown, West Virginia
| |
Collapse
|
|
5
|
Rugg C, Kadoor A, Feeley BT, Pandya NK. The Effects of Playing Multiple High School Sports on National Basketball Association Players' Propensity for Injury and Athletic Performance. Am J Sports Med 2018; 46:402-408. [PMID: 29135275 DOI: 10.1177/0363546517738736] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Athletes who specialize in their sport at an early age may be at risk for burnout, overuse injury, and reduced attainment of elite status. Timing of sport specialization has not been studied in elite basketball athletes. HYPOTHESIS National Basketball Association (NBA) players who played multiple sports during adolescence would be less likely to experience injury and would have higher participation rates in terms of games played and career length compared with single-sport athletes. STUDY DESIGN Descriptive epidemiology study. METHODS First-round draft picks from 2008 to 2015 in the NBA were included in the study. From publically available records from the internet, the following data were collected for each athlete: participation in high school sports, major injuries sustained in the NBA, percentage of games played in the NBA, and whether the athlete was still active in the NBA. Athletes who participated in sports in addition to basketball during high school were defined as multisport athletes and were compared with athletes who participated only in basketball in high school. RESULTS Two hundred thirty-seven athletes were included in the study, of which 36 (15%) were multisport athletes and 201 (85%) were single-sport athletes in high school. The multisport cohort played in a statistically significantly greater percentage of total games (78.4% vs 72.8%; P < .001). Participants in the multisport cohort were less likely to sustain a major injury during their career (25% vs 43%, P = .03). Finally, a greater percentage of the multisport athletes were active in the league at time of data acquisition, indicating increased longevity in the NBA (94% vs 81.1%; P = .03). CONCLUSION While a minority of professional basketball athletes participated in multiple sports in high school, those who were multisport athletes participated in more games, experienced fewer major injuries, and had longer careers than those who participated in a single sport. Further research is needed to determine the reasons behind these differences.
Collapse
Affiliation(s)
- Caitlin Rugg
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Adarsh Kadoor
- University of California San Diego, San Diego, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| | - Nirav K Pandya
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, California, USA
| |
Collapse
|
|
6
|
Bishop M, Astolfi M, Padegimas E, DeLuca P, Hammoud S. Venous Thromboembolism Within Professional American Sport Leagues. Orthop J Sports Med 2017; 5:2325967117745530. [PMID: 29318176 PMCID: PMC5753956 DOI: 10.1177/2325967117745530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Numerous reports have described players in professional American sports leagues who have been sidelined with a deep vein thrombosis (DVT) or a pulmonary embolism (PE), but little is known about the clinical implications of these events in professional athletes. Purpose To conduct a retrospective review of injury reports from the National Hockey League (NHL), Major League Baseball (MLB), the National Basketball Association (NBA), and the National Football League (NFL) to take a closer look at the incidence of DVT/PE, current treatment approaches, and estimated time to return to play in professional athletes. Study Design Descriptive epidemiology study. Methods An online search of all team injury and media reports of DVT/PE in NHL, MLB, NBA, and NFL players available for public record was conducted by use of Google, PubMed, and SPORTDiscus. Searches were conducted using the professional team name combined with blood clot, pulmonary embolism, and deep vein thrombosis. Results A total of 55 venous thromboembolism (VTE) events were identified from 1999 through 2016 (NHL, n = 22; MLB, n = 16; NFL, n = 12; NBA, n = 5). Nineteen athletes were reported to have an upper extremity DVT, 15 had a lower extremity DVT, 15 had a PE, and 6 had DVT with PE. Six athletes sustained more than 1 VTE. The mean age at time of VTE was 29.3 years (range, 19-42 years). Mean (±SD) time lost from play was 6.7 ± 4.9 months (range, 3 days to career end). Seven athletes did not return to play. Players with upper extremity DVT had a faster return to play (mean ± SD, 4.3 ± 2.7 months) than those with lower extremity DVT (5.9 ± 3.8 months), PE (10.8 ± 6.8 months), or DVT with PE (8.2 ± 2.6 months) (F = 5.69, P = .002). No significant difference was found regarding time of return to play between sports. Conclusion VTE in professional athletes led to an average of 6.7 months lost from play. The majority of athletes were able to return to play after a period of anticoagulation or surgery. Those with an upper extremity DVT returned to play faster than those with other types of VTE. Further study is needed to look into modifiable risk factors for these events and to establish treatment and return-to-play guidelines to ensure the safety of these athletes.
Collapse
Affiliation(s)
- Meghan Bishop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew Astolfi
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Eric Padegimas
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Peter DeLuca
- The Rothman Institute, Philadelphia, Pennsylvania, USA
| | | |
Collapse
|
|
7
|
Fortington LV, Bekker S, Finch CF. Online news media reporting of football-related fatalities in Australia: A matter of life and death. J Sci Med Sport 2017; 21:245-249. [PMID: 28663137 DOI: 10.1016/j.jsams.2017.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 06/02/2017] [Accepted: 06/13/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES While deaths in sports settings are rare, they do occur. To develop an understanding of the sports and people most at risk, and to identify opportunities for prevention, routine and systematic data detailing the occurrence of these fatalities is required. There is currently no routine reporting of data of this nature in Australia. As there is often strong community interest in these incidents, the media offers an opportunity for surveillance. However before this can occur, understanding of the terminology used by the media is required. The aim of this study was to identify the terminology most frequently used in online Australian news media coverage of football-related deaths. DESIGN Retrospective review of online news media. METHODS Three databases were searched for online news media reports of people who died while participating in football (all football codes) in Australia. A descriptive analysis of terminology was undertaken to identify the common language applied. RESULTS Thirty-four football-related fatalities in Australia were identified between 2010-2016, via 149 separate articles. The most frequent terms identified in the media items were: Family; Club; Rugby; Football; Player; League; Died; Game; Death; Life; Loved; Hospital; Match; Young; Community; Playing; Friends; Sport; Heart; AFL [Australian Football League]. CONCLUSIONS This study identified terminology used in reporting football-related fatalities in Australia, identifying common reference to terms relating to 'death' as metaphors and the frequent celebration of 'life.' The findings suggest that a reliance on researcher-generated terminology will be insufficient to reflect media discourse in prospective monitoring of sports deaths for surveillance.
Collapse
Affiliation(s)
- Lauren V Fortington
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia.
| | - Sheree Bekker
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia
| | - Caroline F Finch
- Australian Centre for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Australia
| |
Collapse
|