> -----Original Message-----
> From: Robert Williams [mailto:[log in to unmask]]
> Sees GP next day, who does a d-dimer (positive) and starts
> him on a three month course of warfarin.
>
> Q1. Think he should see someone with an interest in sports
> medicine for ECHO and Spiral CT chest?
No. If you think he's got a PE, manage as such (i.e. emergency referral to
inpatient physician of some sort). Nothing to do with sports medicine. If
someone develops a DVT and PE during a race, they are probably better under
a haematologist than a sports physician- check for funny clotting things;
look at iliac and deep lower limb veins for external physical obstruction
etc.
>
> Q2 What do you advise him in respect of training?
I'd go against what's been said by others here: Advice to cut out all
physical activities will probably be ignored. Cut back on training- keep up
the swimming; cycle on exercise bike rather than road, cut back running to a
15- 20 mile week etc should be pretty safe. But I'd like to know more about
external compression first.
As previously commented, I'm not happy with the diagnosis of PE here,
though- I would like a bit more than just d- dimers before starting
warfarin.
>
> Any other comments - 2 cases of "competition DVT/PE" in
> literature (but I have not seen them).
Never seen a lower limb competition thrombus either. Upper limb obviously
fairly common. Mechanism is presumably external compression (I'd guess at
the opening in adductor magnus; possibly by a prominent superficial external
pudendal artery at the saphenous vein; or iliac vein- the last particularly
if the problem was on the left). Most of these would be amenable to surgical
treatment.
Matt Dunn
Warwick
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