The news that arrived this week has shocked the cycling world: the season of Enric Mas Nicolau it suddenly ended, skipping the Return that for the captain of the Movistar it was the main event, the one he cared about the most. All due to thrombophlebitis in the left leg, probably of post-traumatic origin..
A decidedly unusual case, one that strikes and takes out one of its key players in the middle of the season. But what is thrombophlebitis? To learn more, we asked the Jayco AlUla doctor for clarification. Carlo Guardascione.
«Thrombophlebitis – he explains – is a usually acute inflammation of a vein, caused by the formation of a thrombus that has partially or totally obstructed a venous vessel, but sometimes it can also be arterialSo it's an inflammatory condition of a blood vessel. A thrombus is a small blood clot that forms for various reasons. In Mas's case, I read that it was post-traumatic, meaning that, I assume, he probably suffered a calf injury in a fall, and from the hematoma that resulted from the injury, a small clot probably also formed inside a vein in his calf, which obstructed his blood supply in the following days.
Are we talking about something common?
It depends on the area. Thrombophlebitis is a pathological situation that is quite frequent in the general population, but in people who we can consider somewhat predisposed, such as heart patients or people with venous insufficiency, i.e., a situation of hypercoagulability. How can it occur? For example marked dehydration which may be due to a state of illness, such as prolonged diarrhea or prolonged vomiting can cause, in predisposed subjects who already have a predisposition, the formation of thrombi. In young people, however, it is almost always post-traumatic. It is much more frequent in the population, let's call it adult.
What's the problem for an athlete?
Thrombophlebitis is treated with heparin therapy. It generally consists, at least in the initial phase, of subcutaneous injections which can be done once or twice a day depending on the damageHeparin therapy is delicate for the patient: imagine a rider undergoing therapy who falls, suffers trauma, and is at high risk of bleeding, especially internal bleeding, which is extremely dangerous.
How long does the treatment last?
Generally, the treatment of normal thrombophlebitis is on average 4-6 weeks of treatment with heparin or with anticoagulant drugs after the acute phase. This makes sporting activity practically impossible, excessively risky. Of course, if I do archery, for example, the risk of injury is minimal, but that's absolutely not the case with cycling. Or if I play soccer or any other contact sport. The problem is that my blood clotting system in case of injuries is practically blocked..
Does this happen often to cyclists?
No, it's a very rare case. I have to say that in my career, which is now quite long, I think I can count on one hand the cases of thrombophlebitis in competitive cyclists. However, I've seen it more often in adults over fifty or sixty who ride bicycles, but who may already have hypertension, perhaps they have very high blood values and therefore due to previous pathologies they can more easily incur superficial phlebitis and in some cases even thrombophlebitis.
How do you find out?
The diagnosis is made with an ultrasound scan with an arterial and venous Doppler ultrasound which highlights the condition of the blood vessels, so the obstruction is usually at the site of the pain, either slightly above or slightly below. And then you need to administer heparin treatment, which causes anticoagulation within the timeframe I mentioned.
So is the rider and his team's decision to stop him completely for the rest of the season also right?
Certainly, considering around six weeks of treatment, then it also depends on whether it's thrombophlebitis of a rather large vessel, it's clear that the thrombus is larger. Let me explain, A thrombophlebitis of a calf vein is much larger than a thrombus of a foot vein or a hand vein. The treatment time is as it should be. Given the season, it's clear there's no time to recover. It's best to postpone everything until next season. He'll have to stay off work for the first few days, then they'll definitely do another Doppler ultrasound to see if the clot has shrunk.
Does it usually leave any after-effects?
If it heals well, no, because the thrombus is practically dissolved. If the blood flow that is checked again with the Doppler ultrasound is valid, there are no more consequences, especially for a young person like Mas.An adult may still need to take simple anticoagulants for their entire life, such as aspirin. If they have a predisposition for this type of condition.
In the case of a rider who experiences this, is it also a warning sign for the future?
If it is post-traumatic, related to a fall or impact with a blunt object such as the bicycle frame or a hard obstacle on the road, it is quite random. I don't see any alarm bells ringing unless you have hypercoagulability, that is, very high red blood cell count, very high hemoglobin count, and very high platelet count. But in his case it arose a couple of days after the impact, so everything is within the timing, I don't see any consequences.
