Deep Vein Thrombosis and Pulmonary Embolism in a Female Football Player with Calf Pain
Clinical Medicine Research
Volume 6, Issue 3, May 2017, Pages: 64-68
Received: Feb. 8, 2017;
Accepted: Mar. 7, 2017;
Published: Mar. 23, 2017
Views 2172 Downloads 99
Rodrigo Moreira Sales, Medical Department, Olympic Training and Research Center (COTP), Sao Paulo, Brazil; Medical Department, Brazilian Paralympic Committee, Brasilia, Brazil; Discipline of Sports Medicine and Physical Activity, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
Ednei Costa Maia, Discipline of Sports Medicine and Physical Activity, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
Rafael Moreira Sales, Department of Physiotherapy, Estacio de Sa University, Recife, Brazil
Gustavo Gonçalves Arliani, Department of Orthopedics and Traumatology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
Carlos Tadeu Moreno, Medical Department, Olympic Training and Research Center (COTP), Sao Paulo, Brazil; Department of Orthopedics and Traumatology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
Tathiana Rebizzi Parmigiano, Department of Gynecology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
Follow on us
Although many health professionals believe that exercise protects the athletes against thrombosis, it is discussed whether elite athletes are exposed to many thrombogenic acquired risk factors such as: dehydration, hemoconcentration, repeated microtraumas and extended periods of immobilization during travel or injury. Additionally, the use of combined oral contraceptive (COC) may increases the risk of venous thrombosis fourfold in healthy women. We report a case of a 21-years-old professional female football athlete who developed deep vein thrombosis (DVT) followed by pulmonary embolism (PE). The outpatient hypercoagulability workup was negative and the case was associated to the use of COC pills. The patient was treated with rivaroxaban for 5 months, with complete resolution of the symptoms. There are a few cases in the literature of venous thromboembolism (VTE) involving athletes. Cases of VTE attributable to the use of COC are extremely rare in this population. The diagnosis of VTE in athletes is a challenge for physicians, because the symptoms may erroneously be confused with musculoskeletal complaints. Team physicians who work with female athletes should be alert to modifiable risk factors for VTE, as well as able to perform the early diagnosis and initial clinical management of this condition. DVT should be considered as a differential diagnosis of calf pain in women, especially in athletes, due to the well-defined increase on the risk of thrombosis with the use of COC pills.
Venous Thrombosis, Pulmonary Embolism, Combined Oral Contraceptives, Athletes, Football
To cite this article
Rodrigo Moreira Sales,
Ednei Costa Maia,
Rafael Moreira Sales,
Gustavo Gonçalves Arliani,
Carlos Tadeu Moreno,
Tathiana Rebizzi Parmigiano,
Deep Vein Thrombosis and Pulmonary Embolism in a Female Football Player with Calf Pain, Clinical Medicine Research.
Vol. 6, No. 3,
2017, pp. 64-68.
Copyright © 2017 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/
) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
C. Kearon, Natural history of venous thromboembolism. Circulation, 2003. 107(23 suppl 1): p. I-22-I-30.
I. A. Naess, et al., Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost, 2007. 5(4): p. 692-9.
K. Tao and M. Davenport, Deep venous thromboembolism in a triathlete. The Journal of emergency medicine, 2010. 38(3): p. 351-353.
S. V. Konstantinides, et al., 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J, 2014. 35(43): p. 3033-69, 3069a-3069k.
White, R. H., The epidemiology of venous thromboembolism. Circulation, 2003. 107(23 suppl 1): p. I-4-I-8.
C. Huerta, S. Johansson, M. Wallander, and L. A. García Rodríguez, Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the united kingdom. Archives of Internal Medicine, 2007. 167(9): p. 935-943.
V. F. Tapson, Acute pulmonary embolism. New England Journal of Medicine, 2008. 358(10): p. 1037-1052.
K. Moffatt, P. J. Silberberg, and D. J. Gnarra, Pulmonary embolism in an adolescent soccer player: a case report. Med Sci Sports Exerc, 2007. 39(6): p. 899-902.
D. L. Ornstein and M. Cushman, Factor V Leiden. Circulation, 2003. 107(15): p. e94-e97.
K. Erickson and M. E. Powers, Factor V Leiden thrombophilia in a female collegiate soccer athlete: a case report. Journal of Athletic Training, 2013. 48(3): p. 431-435.
T. Hilberg, D. Jeschke, and H. H. Gabriel, Hereditary thrombophilia in elite athletes. Med Sci Sports Exerc, 2002. 34(2): p. 218-21.
G. Grabowski, W. K. Whiteside and M. Kanwisher, Venous thrombosis in athletes. Journal of the American Academy of Orthopaedic Surgeons, 2013. 21(2): p. 108-117.
M. de Bastos, et al., Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev, 2014(3): p. Cd010813.
WHO, W. H. O., Medical eligibility criteria for contraceptive use. 2015.
M. C. Kleinegris, A. J. ten Cate-Hoek, and H. ten Cate, Coagulation and the vessel wall in thrombosis and atherosclerosis. Pol Arch Med Wewn, 2012. 122(11): p. 557-66.
C. Meyering, and T. Howard, Hypercoagulability in athletes. Current sports medicine reports, 2004. 3(2): p. 77-83.
D. Dupras, et al., Venous thromboembolism diagnosis and treatment. Institute for Clinical Systems Improvement, 2013.
C. Kearon, et al., Antithrombotic therapy for vte disease: Chest guideline and expert panel report. Chest, 2016. 149(2): p. 315-352.
B. D. Levine, et al., Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 1: Classification of sports: dynamic, static, and impact. A. Scientific Statement from the American Heart Association and American College of Cardiology, 2015. 132(22): p. e262-e266.