Venous Thromboembolism in Athletes, Including Paget–Schroetter Syndrome: A Narrative Review

Abstract

Background. Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is traditionally linked to immobility, surgery and malignancy, yet it also affects young, apparently healthy athletes. Exercise-related cardiovascular protection coexists with transient exercise-induced hypercoagulability and sport-specific mechanical and environmental exposures, creating a distinctive, easily overlooked risk profile.

Aim. To synthesise the medical evidence on VTE in athletes, with particular attention to Paget–Schroetter syndrome (effort thrombosis of the axillary–subclavian vein), and to critically appraise its pathophysiology, diagnosis, treatment and return-to-play.

Material and methods. Narrative review of case reports, case series, cohort studies and topical reviews addressing hemostasis, thrombophilia, upper- and lower-extremity DVT, PE and anticoagulation in athletic populations.

Results. Athletes are exposed to all three arms of Virchow’s triad through repetitive microtrauma, hemoconcentration, venous stasis during travel and immobilisation, and post-exertional inflammation, frequently compounded by inherited thrombophilia, hormonal therapy or occult malignancy. Paget–Schroetter syndrome typically affects young overhead athletes and is best managed by anticoagulation, catheter-directed thrombolysis and first-rib resection; anticoagulation alone carries high rates of residual obstruction and recurrence. Standard clinical decision rules and athlete physiology, notably a low resting heart rate, may mislead and delay the diagnosis of DVT and PE.

Conclusions. A high index of suspicion, athlete-adapted diagnostics, individualised anticoagulation and structured return-to-play planning are essential. VTE in athletes is both a physical and a psychosocial burden requiring multidisciplinary care.