Philadelphia Eagles quarterback Jalen Hurts is out for the season after the discovery of blood clots in his lungs – a condition also known as pulmonary embolism. It affects 1 in 1,000 people in the U.S. every year. You might not expect it to happen to an athlete. But Dr. Jose Escobar, a cardiothoracic surgeon at Texas Health Denton, explained to KERA’s Sam Baker how it’s possible.
Dr. Escobar: One is stasis of blood, meaning that you’re not moving around much. Professional athletes that spend a lot of time on an airplane are going to be particularly prone to that.
Then you also have damage to the blood vessel, endothelial damage specifically, and that can be from trauma. And obviously a football player’s going to have quite a bit of bruising and trauma from their day-to-day practicing.
Third fact is propensity to have coagulation, meaning to form thicker blood.
There are also genetic predispositions that people can have to thicker blood and to clot more easily.
Baker: What would cause that blood clot to travel to the lungs?
Dr. Escobar: It depends on the burden of clot. If there’s a lot of clot, clot can definitely break off and travel upstream. And it’s even more of a risk if it’s closer to the groin. If it’s a clot that’s in the superficial system that’s in proximity to the deep system where the two veins meet kind of in the groin areas, that would make it more risky.
But once it gets into the deep vein system and once it’s termed a deep vein thrombosis, it’s pretty easy for those clots as the clot burden builds for clots to break off with activity – repetitive motion and things like that – and can certainly travel up to the heart and then the lungs. And that’s what Jalen is dealing with.
Baker: Okay, but for the average person?
Dr. Escobar: We treat these patients conservatively. We don’t always want to put them on blood thinners if the clots are considered low risk and typically below the knee or superficial. But when they are deep vein thrombosis, like what happened with Jalen, then we do want these patients to be seen, whether in the clinic setting, urgent care setting, or in the hospital setting. And if there’s no contraindications, meaning if there is no additional risk for being on blood thinner.
The typical treatment for the average person is to be put on blood thinners and then be given on a follow-up appointment with a vascular specialist to repeat an ultrasound and see if there’s been further buildup of clot.
Most of the time the body takes care of it, as long as their clotting system is relatively normal. But sometimes you have to make sure that there’s not worsening symptoms, especially if you’re talking about coughing or chest pain or things that make you think that something went to the lungs.
Baker: What would be signs or symptoms that this kind of problem is afoot?
Dr. Escobar: Well, swelling in the legs, ankles or feet, pain or tenderness in the legs, any skin changes in terms of color, the discoloration of the legs.
And then when you worry about the lung involvement, you know, if you start having sudden coughing and you could even have a coughing up some blood, having some blood-tinged, sputum in your cough, sharp chest pain or chest tightness, even pain in your shoulder, arm, back or jaw, especially you’re starting to feel like you’re having a tough time breathing, shortness of breath, breathing fast. Especially pain when you’re breathing, you know, we call that pleurisy, but any pain with your deep breaths.
And then obviously if you’re having severe lightheadedness or fast heart beats or feeling like you’re going to faint or the feeling that’s described in medical school is an impending feeling of doom.
Baker: Who’s most at risk for a pulmonary embolism?
Dr. Escobar: Obesity, inactivity, I think females more than men, women that are on any kind of hormone replacement therapy or oral contraceptive, and if they’re smokers. Patients with a family history of blood clots in their family.
Baker: All of that said, how can you avoid such a condition?
Dr. Escobar: I think about wearing compression stockings any time I’m on an airplane for longer than an hour or two, but I’ll even take an aspirin for something like going on an extended flight.
Long car rides, making frequent stops every couple of hours so they get up and take a walk.
Ankle exercises and things like that to try to keep mobility, to keep the circulation moving in your legs when you’re set up to not be mobile for an extended period of time.
But for the average lay person who’s not typically at risk, I think it’s important to recognize the risk factors. Not smoking, if you’re on oral contraceptive or hormonal therapy, if you’re traveling long distances and you have what you knew you’re subjected to stasis of your circulation to take frequent rest breaks and also if you are sitting on a plane just get up and walk around.
RESOURCES:
MedlinePlus: Pulmonary Embolism
Cleveland Clinic: Pulmonary Embolism
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