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Endurance athletes, take the time to read this.
By Matt Simpson

Surprising as it is, about 85% of air travel blood clot victims are usually endurance-type athletes. Well, pat yourself on the back for doing one of the smartest things for your training, your racing, and your life and read on.

The Skinny on Blood Clots:
As an endurance athlete you are perilously flirting with hefty blood clot formations even if you are as sculpted as the Statue of David, have a V02 max paramount to Steve Prefontaine's, and the most upsetting news received after your annual physical is that they've run out of cherry lollipops.

A blood clot (or thrombosis) is basically blood that has been converted from a liquid to a more gelatinous-solid state. Normal conditions of clotting follow Haemostasis: The process by which the body stops blood loss whenever a vessel is severed or ruptured. If the injury is large, platelet 'plug' formations aggregate at the site of the injury, which initiate blood coagulation. With the help of complex enzymatic reactions, fibrin strand formations create a meshwork to trap red blood cells and other platelets, forming what we see as the mature clot.

More applicable to the endurance athlete is the Deep Vein Thrombosis (DVT), which is normally, but not always, located in the legs. Where a DVT distinguishes itself from a normal thrombosis is that the DVT occurs inside the blood vessel rather than outside like normal clots. If the DVT is large enough it can partially or completely block blood flow. Now, you are flirting with the Grim Reaper. If the clot breaks free it may then take an unfettered happy field trip through the blood stream, ending with an abrupt rest-room break at the lungs where it there could obstructs blood flow. If you have yet to attain your angel wings, congratulations, you just found the zenith of your pain threshold via surviving a Pulmonary Embolism (PE).

I suppose you are sitting here now pondering, "Wow, this guy is a walking buzz kill!"

No need to get your Ironman underwear all in a wad just yet, the next bit of information applies directly to you.

Why Endurance Athlete are at an Elevated Risk for a DVT:
Well, within the scientific community the factors that show a predisposition to venous thrombosis are known as: Virchow's Triad and include:

1) Changes in the vessel wall (a.k.a. the endothelium)
2) Alterations in blood flow (ex. haemostasis)
3) Aberrations in blood constituents (ex. Hypercoagulability or "uber-clottable").

Comparing Endurance Athletes Respectively to Vichrow's Triad:
1) Sure fire ways to make changes to the vessel walls include a flailing arm hitting your goggles in the swim, twisting your ankle in the transition area, or wrecking your bike. Heck, slipping and sliding your way off a porta-potty seat and then smacking your head against the hand sanitizer dispenser could also transpire. Unfortunately, blatant examples as these are not required to dictate a threat. When you race, have you ever witnessed higher blood pressure or an elevated heart rate (greater flow)? Could increased blood pressure and flow cause latent damage to the vessel wall? The answer is 'yes'. Unbeknownst to you, any of the previous modifications to the vessel walls could be initiating the blood coagulation process.

2) Alterations in blood flow may occur when you have gone full-tilt for a long duration and abruptly come to a halt at the finish (or med tent). Time to lay supine! After all, you've earned it! Let the downward spiral begin. Yearning to expedite the homeward bound journey so you can pet Piglet, your pampered Pug, you endure the long flight or ride in cramped quarters asleep, inactive. By mimicking an Idaho potato, greater jeopardy of clot formation is knocking at your door.

3) As an endurance athlete, you tend to have both a lower resting HR and a greater blood volume than your sedentary friends. Subjecting yourself to dehydration removes water from the blood increasing its thickness. Now you have completed the grocery list of a slower pulse, thicker blood, and possibly elevated blood pressure. Combine it with #1, #2, or both and you've made yourself a perfectly baked blood clot cake!

How to Minimize the Risks:
1) Remove as many factors from the Vichrow's Triad as possible. Obviously, you can't spin the world backwards as Superman did to 'un-wreck' your bike. However, in such an incident you can slow down your heart rate a bit and lower your blood pressure by simply taking a few breaths to relax.

2) After a race, do all you can to cool down properly and rehydrate to the best of your abilities. At all costs, avoid wearing tight clothing or sitting idle for more than two hours. If confined to a space you can do leg exercises by flexing your toes and calves to promote blood flow to and from the lower extremities (again, where most DVT's occur).

3) Most likely, you have seen a plethora of articles and advertisements addressing hydration. Aside from it benefiting your performance, maintaining proper hydration also sustains your higher blood volume, which reduces strain on your cardiovascular system and diminishes the dangers of blood clotting.

Symptoms of a Blood Clot:
Some of the symptoms of a blood clot involve pain and swelling or 'blood pooling' in the extremities, such as the calves. You may even be able to feel your heart beat (major throbbing) in your extremities and have associated pain involved. Get to a doctor and mention your concern with blood clots. If you have pain in your chest or hindered breathing you very well could be experiencing a PE and time is of the essence to find medical help. Go get it!

Closer to Home than You Think:
From the bottom of my heart, I share this to inform you of the dangers of a thrombosis in endurance athletes. I'm a high-end age-grouper who suffered a DVT after a bike wreck, followed by a dehydrated state and a long sedentary flight home the day after finishing Ironman CDA in 2005. After almost passing out from futile efforts to remove the blood-dried bandages from my wounds I trekked to the ER where they discovered within my overly inflamed injuries that latent danger. I am so grateful for the ER's discovery before it could have developed into a PE, which could have cost me my life. For the next six months my athletic activities were restricted due the arduous recovery process, anticoagulants (easier blood flow), and the weekly blood tests. However, I walked away gaining so much and just a few weeks ago posted a PR in a half IM. This great feeling of accomplishment became infinitesimally small after one phone call.

My closest friend Stephen Schumacher (ranked 11th nationally in USAT in the 25-29 age group), also a fellow Ironman, suffered not only a DVT, but also a PE. His was derived from a stress fracture in his hip, a slightly dehydrated state, and halt to activity due to his hip injury. He won his race, fell over from the pain from the stress fracture and a week later his unknown DVT turned into a PE. In the hospital I witnessed him in more pain than I could fathom, even with all the morphine. His survival was a miracle given that most PE's are discovered post mortem. Thankfully now at home, he is able to start down the long road of recovery.

Steve and I each successfully completed the Virchow's Triad, suffered blood clots, and yet survived (not always the case). At the time the clots happened to us we were both in our late 20's, highly trained athletes in great shape, and paying attention to nutrition, hydration, and recovery. I would like to reiterate that you don't have to sustain a known injury to suffer a DVT, given that many times a stress can go unnoticed. With that said, please keep on 'TRI-ing' and don't fear being the endurance athletes that you've striven so hard to become, but simply be proactive and grasp that it truly could happen to you or someone you know. Thanks and please spread the word.

References:
http://www.airhealth.org/athletes.html

iii D. J. Brotman, S. R. Deitcher, G. Y. Lip, et al:
Virchow's triad revisited.

http://www.exanta.com/33338_33627.aspx?caid=33627

Deep vein thrombosis. NHS Direct Health Encyclopaedia.
www.nhsdirect.nhs.uk
accessed 21 November 2005.

D. J. Brotman, S. R. Deitcher, G. Y. Lip, et al:
Virchow's triad revisited.

Southern Medical Journal, Birmingham, Alabama, 2004, 97 (2): 213-214.

http://www.answers.com/topic/virchow-s-triad

http://www.pponline.co.uk/encyc/0420.htm

Hypervolemia and Cycling Time Trial Performance, Medicine and Science in Sports and Exercise, vol. 26(4), pp. 503-509, 1994
http://www.airhealth.org/athletes.html

Advice on travel-related DVT. Department of Health.
www.dh.gov.uk
accessed 17 November 2005.

International travel and health. World Health Organisation. 2005.
www.who.int

Chestnut, Cameron May 2, 2006:
Student of the Sport: Danger of the thrombus
http://www.insidetri.com/portal/news/news.asp?item=101039

Matt Simpson, Amateur Triathlete
Matt is an analytical chemist and intrigued by biochemical, molecular, and physiological aspects within athletic performance. As an advanced endurance athlete, he primarily races: half IM, full IM, and off-road running (marathons and ultras). On your next trail run, flip up your visor and look to the sky; he may be above you rock climbing or bouldering. Next stop, IM WI 2006! Contact info: optimistic4life7@yahoo.com