Sidelined Canuck gets people talking about clots

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It was a crushing disappointment.

The day of the Vancouver Canucks’ crucial final game in the Edmonton Oilers series, star Canuck forward Brock Boeser was pulled from the lineup for medical reasons.

The rumoured problem was a blood clot in his leg.

Thrombosis kills one in four people

Many wondered how an athlete in peak physical shape could develop the condition, whose medical name is venous thromboembolism (VTE).

It prevents blood from flowing normally through the body and can harm important organs like the heart and lungs. It affects one in 1,000 Canadians each year.

According to the Cleveland Institute, clots cause one of every four deaths worldwide.

VTE is an umbrella term that includes deep-vein thrombosis (clot in legs) and pulmonary embolism, which occurs if a clot travels to the lungs.

Boeser has since confirmed that he had blocked a shot with his leg in Game 1 of the series against Edmonton and had developed a bruise. Then a week later, his calf became painful. Finally, a scan after Game 6 showed a clot that prevented him from playing in Game 7, which the Canucks lost. He had developed deep-vein thrombosis.

Athletes’ lifestyles put them at risk

While members of the public may have wondered how a blow that is commonplace in pro hockey became a clot risky enough to stop Boeser from playing, Dr. Anna Rahmani, co-director of the St. Paul’s Hospital Thrombosis Clinic, does not.

“Independent of how healthy athletes are, their lifestyle can put them at risk for blood clots,” she explains. There’s not just one cause. “Clots in athletes are multifactorial.”

Those who play aggressive contact sports like Boeser are at constant risk of trauma to the body, as the hit to his calf showed. If injuries are serious enough, the athletes must spend time immobilized – in a cast, or bed bound – while they heal. That lack of movement can add to the risk of clots.

Pro athletes also travel long distances to and from games, where they aren’t active.

The intense cardiovascular training, trauma, injury, inflammation, dehydration, and hemoconcentration (a thickening of the blood) are all experienced by athletes.

Female athletes (and women in general) who take estrogen-containing oral contraceptives are at a higher risk.

And finally, athletes, like anybody, may have a genetic predisposition for clots.

Athletes receive diagnosis later than the rest of us

Athletes are often diagnosed with clots much later, adding to their risk. “Due to their injuries, athletes often don’t seek medical attention. They get so many injuries that may not be clots,” says Rahmani. She says athletes get diagnosed with clots later than the average person. Their high pain tolerance may make them brush off discomfort that could be thrombosis.

A 2021 study from Germany’s University of Wuppertal found that athletes with thrombosis can experience more than 25 misdiagnoses and an average diagnosis time of 56 days. “In our clinic, an average diagnosis time can be as short as three days and usually before three weeks,” says Dr. Rahmani.

Dr. Rahmani says Boeser’s case – while crushing to him, his team and the fans – is a “golden moment” to get people talking about blood clots, how to recognize the symptoms and how to get treatment. “The condition doesn’t get the attention it deserves,” she says, noting it can become an emergency if medical care isn’t sought out quickly.  

Thrombosis Canada has developed a mnemonic called CLOTS to help people know the symptoms.

An infographic using the mnemonic CLOTS helps people know the symptoms.

If the clot is in the leg area, there is usually pain, swelling, heat and redness, says Dr. Rahmani. “It can feel like a charley horse or a muscle cramp in the calf. A pulmonary embolism, caused when the clot moves to the lungs, can cause stabbing chest pain, shortness of breath, bloody cough or even cause fainting.”

Blood-thinning medications are the front-line treatment for clots, including warfarin or Direct Oral Anticoagulants. They prevent the clot from growing, while the body works to break it down. Recovery is an individual thing and depends on how effective the body is at breaking down the clot. Mobility is encouraged during the treatment period if moving isn’t too painful for the patient.

Boeser has confirmed he is on blood thinners, and the good news is that he is cleared for offseason training. But because the meds carry with them a bleeding risk, he’s going to have to be careful of injuries.

For more information, visit Thrombosis Canada.

Story by Ann Gibbon, Providence Health Care


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