Deep Vein Thrombosis in Lower Extremity of a Female Collegiate Volleyball Athlete

A Case Study

Abstract

Deep vein thrombosis (DVT) occurs when a blood clot forms in deep veins in the body, usually in the lower extremity. DVT is commonly seen in older or hospitalized patients. This case is unique because the patient, is a 20-year-old female division III collegiate volleyball athlete, which is not the typical age or population affected by DVT or clotting disorders. The patient presented with swelling, pain, and decreased knee flexion (3/5) and plantarflexion (4/5) strength in her left lower extremity. These impairments reduced her ability to walk or run. The patient’s athletic trainer (AT) incorrectly diagnosed her with a left gastrocnemius muscle strain, resulting in contraindicated treatments. The AT referred the patient to the team physician, who referred her to the Emergency Department (ED) where she received a real-time grayscale and Doppler ultrasound of the left lower extremity deep venous structures, leading to the DVT diagnosis.  The patient received a dose of Lovenox, an intravenous anticoagulant, by the ED physician. The following day, she began 15 mg of Xarelto, twice per day for 21 days, to dissolve the blood clots. She could not participate in volleyball for approximately two weeks, which reduced her ability to socialize with teammates and coaches. The Wells’ scoring system is a clinical prediction tool to identify patients with low risk of being diagnosed with DVT. The AT did not include this tool in their initial evaluation, leading to a delay in the diagnosis and treatment. Although the patient reported that she had a positive outcome, ATs should be familiar with the Wells Clinical Prediction Rule. Blood clots in veins can dislodge and travel through the bloodstream. The loose clot can block blood flow in the lungs, forming a pulmonary embolism. Early diagnosis can prevent this life-threatening condition.