A case of unprovoked venous thromboembolism in a marathon athlete presenting atypical sequelae: What are the chances?

Marathon runners are exposed to multiple thrombogenic risk factors including dehydration and hemoconcentration, injury and inflammation, long-distance travel between events, and contraceptive usage. However, despite awareness about thromboembolism and several case reports detailing life-threatening hypercoagulopathies in athletes, the prevalence of venous thromboembolism in marathon runners remains uncharted. There is a lack of data and evidence-based guidelines for these athletes and for healthcare providers, including general medical practitioners and sports physicians. We present an episode of unprovoked deep vein thrombosis (DVT) and pulmonary embolism (PE) in a female marathon athlete who presented with atypical sequelae over the course of 8 months, and identify some "easy-to-miss" warning signs and symptoms. Through dialogue with the patient regarding their personal questions and anxieties surrounding idiopathic DVT-PE, we identify a clear need for more accessible information and comprehensive research concerning the detection, prevalence, and long-term management of venous thromboembolism in athletes. We discuss the possibility that being an athlete might constitute a more significant risk factor for venous thromboembolism than is currently estimated by commonly used diagnostic protocols and conclude that there is quite possibly a need for more specific clinical guidelines for athletes in this area.