Management of Anticoagulation in Athletes

Venous thromboembolism (VTE) in athletes presents a unique clinical challenge that contradicts the traditional perception of athletes as low-risk individuals. While regular exercise mitigates cardiovascular risk and improves venous flow through frequent mobilization, injuries, inappropriate mechanics of participation, comorbid medical conditions, recreational utilization of performance-enhancing medication, and underlying thrombophilia all create unique circumstances for thrombosis in this patient population. Individual consideration of anticoagulant agent use, duration of treatment, and pauses in treatment depend on underlying bleeding and thrombosis risk and level of activity and lifestyle for each patient. Continuation of anticoagulation after return to participation in sports also requires thorough risk-benefit assessment factoring in overall health, and hinges partially on the ability to reverse the effect of anticoagulation in dire situations. Guidance about continuation of a particular sport if long-term anticoagulation is needed depends on shared decision-making about morbidity and quality of life. Adjunct methods to prevent further thrombosis and manage post-thrombotic syndrome are also important for athletic longevity. There is a growing body of literature regarding evaluation and management of athletes with thrombosis, and the authors aim to summarize recommendations as they apply to pediatric and adult athletes. However, it is noted that continued study of this topic is needed to create more generalized recommendations rather than considerations for individual patient management, as discussed within this article.