 |
[email protected] |
 |
3275638434 |
 |
 |
| Paper Publishing WeChat |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
Pulmonary Thromboembolism in a Soccer
Player after COVID-19 Infection: Case Report
Paulo Roberto Santos-Silva, Júlia Maria D'Andrea Greve, Fernando Ribeiro, Cristian Alvarez, Fernanda Firmino Giachetta, Marcelo Hiro Akiyoshi Ichige and Guilherme Veiga Guimarães
Full-Text PDF
XML 770 Views
DOI:10.17265/2332-7839/2023.01.001
Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-010, Brasil
Institute of Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, 3810-193, Portugal
Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Concepcion, 8370035, Chile
Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 05403-000, Brasil
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, is characterized by an increased risk of thromboembolic events. However, more than 80% of patients are asymptomatic or have only minor/mild symptoms. In addition, diagnosing thromboembolism in athletes is challenging, as symptoms can be confused with musculoskeletal complaints or physical deconditioning. Case presentation: Here we report the case of a previously healthy 34-year-old professional soccer player with COVID-19 infection and genetic predisposition to thrombosis. At baseline, he was fit, had no symptoms, did not require hospital admission due to a COVID-19 infection, and was started on a five-day course of azithromycin and dexamethasone therapy. After 10 days of returning to professional activity, he developed pulmonary embolism following a COVID-19 infection during a physical exercise session. Angiotomography showed positive acute and subacute pulmonary thromboembolism, being treated with rivaroxaban 20 mg/day continuously. The shared decision-making between the medical team and the athlete was not to return to professional soccer, given the quantifiable risk. Considerations: This case illustrates the potential risk of COVID-19-induced pulmonary thromboembolism, which can be affected by genetic predisposition and dexamethasone therapy or the consequences of COVID-19. In this clinical period, the athlete’s condition may be overlooked due to the masking effects of other clinical conditions and physical abnormalities. The residual effects of COVID-19 disease can appear late, requiring caution and follow-up by the medical team before releasing the athlete into a training program.
COVID-19, SARS-CoV-2, pulmonary embolism, anticoagulation, athlete
Journal of Sports Science 9 (2023) 1-6
[1] Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., et al. 2020. “Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China.” The Lancet 395 (10223): 497-506.
[2] Teimury, A., Khameneh, M. T., and Khaledi, E. M. 2022. “Major Coagulation Disorders and Parameters in COVID-19 Patients.” European Journal of Medical Research 27 (1): 25.
[3] Al-Aly, Z., Xie, Y., and Bowe, B. 2021. “High-Dimensional Characterization of Post-acute Sequelae of COVID-19.” Nature 594 (7862): 259-64.
[4] Kim, J. H., Levine, B. D., Phelan, D., Emery, M. S., Martinez, M. W., Chung, E. H., et al. 2021. “Coronavirus Disease 2019 and the Athletic Heart.” JAMA Cardiology 6 (2): 219.
[5] Martinez, M. W., Tucker, A. M., Bloom, O. J., Green, G., DiFiori, J. P., Solomon, G., et al. 2021. “Prevalence of Inflammatory Heart Disease among Professional Athletes with Prior COVID-19 Infection Who Received Systematic Return-to-Play Cardiac Screening.” JAMA Cardiology 6 (7): 745.
[6] Schellhorn, P., Klingel, K., and Burgstahler, C. 2020. “Return to Sports after COVID-19 Infection.” European Heart Journal 41 (46): 4382-4.
[7] Cannegieter, S. C., and Klok, F. A. 2020. “COVID‐19 Associated Coagulopathy and Thromboembolic Disease: Commentary on Interim Expert Guidance.” Research and Practice in Thrombosis and Haemostasis 4 (4): 439-45.
[8] Ibarrola, M., and Dávolos, I. 2020. “Myocarditis in Athletes after COVID-19 Infection: The Heart Is Not the Only Place to Screen.” Sports Medicine and Health Science 2 (3): 172-3.
[9] Barker-Davies, R. M., O’Sullivan, O., Senaratne, K. P. P., Baker, P., Cranley, M., Dharm-Datta, S., et al. 2020. “The Stanford Hall Consensus Statement for Post-COVID-19 Rehabilitation.” British Journal of Sports Medicine 54 (16): 949-59.
[10] Konstantinides S, Meyer. G. 2019 “Management of acute pulmonary embolism 2019: what is new in the updated European guidelines?” Intern Emerg Med. 15(6): 957-966.
[11] Adams, M., Kitic, C., Wu, S., Fell, J., and Zadow, E. 2018. “Acquired and Genetic Thrombotic Risk Factors in the Athlete.” Seminars in Thrombosis and Hemostasis 44 (8): 723-33.
[12] Posthuma, J. J., van der Meijden, P. E. J., Ten Cate, H., and Spronk, H. M. H. 2015. “Short- and Long-Term Exercise-Induced Alterations in Haemostasis: A Review of the Literature.” Blood Reviews 29 (3): 171-8.
[13] Van Zaane, B., Nur, E., Squizzato, A., Gerdes, V. E. A., Büller, H. R., Dekkers, O. M., et al. 2010. “Systematic Review on the Effect of Glucocorticoid Use on Procoagulant, Anticoagulant and Fibrinolytic Factors.” Journal of Thrombosis and Haemostasis 8 (11): 2483-93.
[14] Smith, J. E. 2003. “Effects of Strenuous Exercise on Haemostasis.” British Journal of Sports Medicine 37 (5): 433-5.
[15] Ruíz-Giménez, N., Suárez, C., González, R., Nieto, J., Todolí, J., Samperiz, Á., et al. 2008. “Predictive Variables for Major Bleeding Events in Patients Presenting with Documented Acute Venous Thromboembolism. Findings from the RIETE Registry.” Thrombosis and Haemostasis 100 (7): 26-31.
[16] Tay, M. Z., Poh, C. M., Rénia, L., MacAry, P. A., and Ng, L. F. P. 2020. “The Trinity of COVID-19: Immunity, Inflammation, and Intervention.” Nature Reviews Immunology 20 (6): 363-74.