Thromboembolic disorders: guidance for return-to-play

Venous thromboembolism (VTE) is a major cause of morbidity and mortality. Treatment for VTE in athletes is similar to nonathletes. Early treatment of deep venous thrombosis (DVT) with bed rest and anticoagulation has given way to anticoagulation with early mobilization. Thrombolysis, preferably catheter-directed thrombolysis (CDT), may be used in select patients with upper extremity DVT (UEDVT). Surgical procedures should be reserved for those athletes with UEDVT who fail initial therapy. Compression devices are advocated for the treatment of postthrombotic symptoms (PTS) in lower extremity DVT (LEDVT) and UEDVT. Athletes with DVT should be encouraged to start a gradual return to activities of daily living (ADL) the day they begin anticoagulation therapy. A structured return-to-training program with progressive increase in intensity can begin shortly after ADL mastery, provided the athlete is monitored carefully for recurrence of VTE. Athletes should not engage in contact or collision sports until anticoagulation therapy is complete.