Hypercoagulability in athletes.

Risk factors for thromboembolism are well known, and athletes are placed under conditions that can result in exposure to several of these risk factors, which include travel, trauma, immobilization, hemoconcentration, and polycythemia. Presence of a genetic hypercoagulable disorder adds additional risk. Overall management is no different than in nonathletes. Thrombolysis is strongly recommended for upper extremity deep venous thrombosis (DVT) coupled with surgical decompression of obstructive structures if indicated. Thrombolytic therapy does not appear to be necessary for treatment of lower extremity DVT. Prevention of DVT with travel can be achieved through general techniques such as leg exercises, hydration, and loose fitting clothes. Aspirin before travel shows some benefits of protection, but individuals at higher risk may need low molecular weight heparin. Athletes should be screened during preparticipation physicals for thromboembolic risk. Individuals on anticoagulation therapy should not participate in collision or contact sports. Return to play with gradual increase in intensity is recommended with careful monitoring for recurrent venous thromboembolism and management of post-thrombotic symptoms.