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Athletes and blood clots: individualized, intermittent anticoagulation management
Author(s) -
Berkowitz J. N.,
Moll S.
Publication year - 2017
Publication title -
journal of thrombosis and haemostasis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.947
H-Index - 178
eISSN - 1538-7836
pISSN - 1538-7933
DOI - 10.1111/jth.13676
Subject(s) - dosing , medicine , athletes , pharmacodynamics , intensive care medicine , venous thromboembolism , warfarin , physical therapy , pharmacokinetics , pharmacology , surgery , thrombosis , atrial fibrillation
Essentials Athletes on anticoagulants are typically prohibited from participation in contact sports. Short‐acting anticoagulants allow for reconsideration of this precedent. An individualized pharmacokinetic/pharmacodynamics study can aid patient‐specific management. Many challenges and unresolved issues exist regarding such tailored intermittent dosing.Summary Athletes with venous thromboembolism ( VTE ) are typically prohibited from participating in contact sports during anticoagulation therapy, but such mandatory removal from competition can cause psychological and financial detriments for athletes and overlooks patient autonomy. The precedent of compulsory removal developed when options for anticoagulation therapy were more limited, but medical advances now allow for rethinking of the management of athletes with VTE . We propose a novel therapeutic approach to the treatment of athletes who participate in contact sports and require anticoagulation. A personalized pharmacokinetic/pharmacodynamics study of a direct oral anticoagulant can be performed for an athlete, which can inform the timing of medication dosing. Managed carefully, this can allow athletic participation when plasma drug concentration is minimal (minimizing bleeding risk) and prompt resumption of treatment after the risk of bleeding sufficiently normalizes (maximizing therapeutic time).