Are athletes / low HR people at greater risk of DVT than non-Athletes?

Ask a Cycling Coach Podcast
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Hi All -

I’m writing this from a hospital bed (more on that below) and am wondering:

Are there any studies in the scientific literature regarding 'well trained athletes" (or maybe more broadly, people with a naturally ‘low resting HR’) having a higher risk or prevalence of DVT (i.e. perhaps from flying, etc.) than “non-athletes”?

For ‘well trained athletes’ let’s broadly call it a Cat 1/2 and above type road cyclists & MTB’ers. (for ‘low resting HR’…well, I’m not sure where to put the cutoff value for that).

Reason I ask – I’ve been living in Denmark as an American expat for past 2.5 years. This was a company sponsored ‘business trip’ where I was sent here for a project and they are now moving me back home to California. My project in Denmark has concluded, and I’ve made plans to return to the US (i.e. San Francisco…10 hour direct flight from Copenhagen) and have spent the past months readying for the trip…i.e. shipping bikes back home!, closing out housing arrangements, booking flights blah blah, etc.

Part of my preparation for back home was signing up for Moab Rocks Stage Race in the Spring, and starting Sweet Spot Base High Volume I back at beginning of September, and just finishing up SSBHVII and starting up a short Build period to work on my ceiling a bit, etc.

However, disaster has stricken me – Literally during my planned, let’s- say-good-by -celebratory “last ride in Denmark” ride (road) with some Danish friends here, I slipped on some wet leaves going like 1 mph in a parking lot and slammed onto my hip HARD resulting in a fracture of the neck of my femur.

Yes, I literally broke my leg 5 days before my planned move back to the US (again, a 10 hour, direct, flight).

So here I am writing this question from my Danish hospital room, recovering from a successful surgery where 3 screws were inserted into my femur…and wondering how / when I am going to fly back home!! Obviously, my planned flight home 5 days from now is completely out of the question…and am wondering if returning before the end of the year (i.e. 3 - 4 weeks from now) is realistic.

I’m thinking 4 - 6 weeks out from flying is more realistic, but due to a range of factors, I really do need to get home as soon as possible, so am hoping for sooner.

I know with my recent surgery , I have a high (super high? lol) risk of DVT on such a long haul direct flight…but I am wondering if also as a life-long athlete, now Masters (age 45) if I am at higher risk? My resting HR is generally in the low-40’s, and I have a history of low blood pressure as well (enough to nearly always cause gasps here at the hospital when they check it…i.e. like 96/59 when they first admitted here, to 118/60 this morning (i think that’s what it was anyway).

Does the combination of being a life long endurance athlete, my age (45), my recent completion of a dedicated training program (i.e. SSBHV1 and 2) and nearly 9,000 miles of pavement and dirt cycling just this year (which is a typical year for me), low blood pressure, low resting HR PLUS the surgery…put me at greater risk than someone who has NONE of those athletic attributes, but had also had the surgery :slight_smile:

Is there anything in the literature that can provide insight?

Thanks,
Ron Shevock

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I don’t know about DVT risk for athletes. But I’ve had a few ankle surgeries where I flew to another city for surgery, then flew back home. For each return flight (4 hours), I injected a vial of blood thinner to prevent clots during the flight. So maybe something to ask your doctor/surgeon about.

Sorry to hear about your injury. Heal up well!

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This is a question you need to ask your surgeon, IMO. Commiserations on the injury and I hope you make a speedy recovery and are back on the bike soon in the New Year.

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absolutely…of course. I will most certainly will be interacting with surgeon and doctors constantly on this and in the end, it is their advice that I would follow.

But I was curious if the anyone had ever come across anything in the literature.

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As someone who has had a DVT (and PE), I would say your increased risk comes form the immobilization of your leg, not your athletics status. And yes, it is definitely higher right now.

As noted above, you should speak to you doc about the risk flying home…and potentially investigate using Lovenox as a preventative blood thinner before the trip.

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Side note…when I had my hernia op 2 months ago, I had to go off my thinners ebfore the op…and then needed to use Lovenox to help get my blood back to the prescribed “thinness”.

Injected myself for about 10 days…by the end, my abdomen looked like I was a junkie. 5 bruises on each side. My technique clearly needs help. :rofl:

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I had 2 unprovoked blood clots early this year, one in my upper calf and one in my lung. I was put on Xarelto for 3 months and had an entire barrage of tests including blood, urine, ultrasound and x-rays, didn’t find a thing. I hadn’t flown for over a year, no injuries and i’m pretty active.
My doctor did mention my lower than normal heart rate and we discussed that dehydration can also put you at higher risk of throwing a clot. At the end of everything no real cause has been identified and the specialist said that there’s a small percentage of people that develop unprovoked clots. I’m off Xarelto now and just taking an aspirin a day.

Good luck with your recovery.

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Thanks russ.

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So this is not a peer reviewed article, but it points to a case report that is relevant to my question: Why even athletes can be at elevated risk of blood clots - The Globe and Mail

Would love to read the case report that is referenced and that highlighted in bold below:

"The risk factors for blood clots and pulmonary embolism can be grouped into three categories: how prone your blood is to clotting; how smooth or damaged the walls of your blood vessels are; and how vigorously your blood flows.

As it happens, endurance athletes are prone to all three risk factors, explains Dr. Claire Hull, a medical researcher at Swansea University in Wales.

She is the lead author of a recently published case report on a 29-year-old marathon runner who suffered a blood clot that went undiagnosed for eight months.

Their findings:

1. Dehydration and inflammation make your blood more prone to clotting;
2. Physical trauma like muscle strains can damage blood vessel walls;
3. Low blood pressure and a low resting heart rate allow blood to pool during periods of immobility"

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Back in the EPO days blood clots were a concern for cyclists because their resting HR and blood flow would get so low due to high hematocrit. You hear stories of cyclists being woken up at night to walk around so blood clots wouldn’t form. But that was pretty extremes. Hematocrits of ~60.

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Good point…had forgotten that, but do remember now that you mention it.

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Quick update to close the loop: I ended up taking my 11.5 hour long-haul flight from Copenhagen to San Francisco on December 30th, which was a few days past my 3-week post-op date. This was the earliest any doc would allow me to fly so close to my femur repair surgery and the caveats were: fly in first class with a fully reclinable seat (check) and inject myself with heparin before and after flight (check).

Everything went off without a hitch and I’m safely back in NorCal, I’m 6 weeks post-op now and going through PT and putting in the hours already on the Kickr with solid Zone 2 endurance TrainerRoad workouts using the same FTP I was using before the injury and it’s working out fine. Just waiting to get clearance to start riding outside again, but I have clearance to wail away on the bike as I see fit as long as I don’t go into pain (which hasn’t been an issue).

Looking forward to ramping things back up again. Looking at this as a beneficial ‘reset’ or rest period rather than a set back :slight_smile:

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Cool…glad to hear you didn’t clot out in the middle of the flight!! :stuck_out_tongue_winking_eye:

Seriously, good to hear you are OK and back at it!!

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  1. Yes, DVT at altitude is more prominent among “endurance athletes” if you count “AIRHEALTH.org” as a reliable source. (I have not investigated any part of their methodology).
    http://www.airhealth.org/athletes.html via runnersworld (I wonder how much of the data is related to post-race travel where the bodies have all kind of micro-trauma from the exertion, but then again, a broken femur and resulting surgery is likely harder on all systems than a 3 hour tempo run).
  1. That’s one hell of a positive attitude, if a touch crazy.
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nah not crazy…just a reframe technique. One I’ve employed successfully in the past when I underwent ACL reconstruction about 15 years ago, so doing the same here. My attitude / happiness / drive is driven by outlook, not circumstance.

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Only because it was on doctor’s orders, you understand. :laughing: