From the Guidelines
For an NBA player with DVT in the right upper extremity, the recommended treatment is immediate anticoagulation therapy, typically with low molecular weight heparin (LMWH) such as enoxaparin 1 mg/kg twice daily subcutaneously, followed by transition to oral anticoagulants like apixaban or rivaroxaban for at least 3 months. This approach is based on the guidelines for antithrombotic therapy for VTE disease, as outlined in the American College of Chest Physicians evidence-based clinical practice guidelines 1.
The treatment plan should include:
- Immediate anticoagulation therapy to prevent clot propagation and allow for natural dissolution
- Transition to oral anticoagulants for long-term management
- Temporary cessation of basketball activities and contact sports until cleared by a physician, usually after 3-6 months of treatment and resolution of symptoms
- Gradual return to play protocol under medical supervision, starting with non-contact drills and progressing to full participation
- Consideration of compression garments for the affected arm during recovery and future play
- Evaluation for underlying causes such as thoracic outlet syndrome or effort thrombosis
This approach is supported by the guidelines, which recommend anticoagulant therapy for patients with VTE, including those with upper-extremity DVT 1. The guidelines also emphasize the importance of individualized treatment decisions, taking into account the patient's risk of recurrent VTE and anticoagulant-related bleeding. In the case of an NBA player, the risk of pulmonary embolism and the need to minimize downtime and optimize recovery must also be considered.
Key considerations in the treatment plan include:
- The risk of pulmonary embolism, which is higher in patients with upper-extremity DVT
- The need to minimize downtime and optimize recovery to allow the player to return to competition as quickly and safely as possible
- The importance of addressing potential underlying causes of the DVT, such as thoracic outlet syndrome or effort thrombosis, to prevent recurrence and maintain the player's long-term health and career.
From the Research
Implications of a Deep Vein Thrombosis (DVT) in the Right Upper Extremity
- A DVT in the right upper extremity in a National Basketball Association (NBA) player can have significant implications for their health and career 2
- The condition, also known as Paget-Schroetter syndrome, typically develops in young, healthy males subjected to repetitive overhead motions, resulting in compression and thrombosis of the subclavian vein 2
- Treatment for DVT in the upper extremity often involves a combination of surgical and pharmacologic interventions, including anticoagulation therapy with medications such as apixaban 3, 4, 2
Anticoagulation Therapy
- Apixaban is an oral factor Xa inhibitor that has been shown to be effective in treating acute venous thromboembolism, including DVT in the upper extremity 4, 2
- The medication is typically administered in a fixed dose, with a higher dose (10 mg twice daily) used for the first 7 days, followed by a lower dose (5 mg twice daily) for ongoing treatment 4, 2
- Studies have demonstrated that apixaban is noninferior to conventional therapy for the treatment of acute venous thromboembolism and is associated with significantly less bleeding 4
Considerations for NBA Players
- NBA players with a DVT in the right upper extremity may require individualized treatment plans, taking into account their specific health needs and the demands of their sport 5
- The use of anticoagulation therapy, such as apixaban, may need to be carefully managed to minimize the risk of bleeding and other adverse events, while also ensuring effective treatment of the DVT 3, 4, 2
- Further research is needed to determine the safety and efficacy of apixaban for the treatment of pediatric anticoagulation, particularly in upper extremity deep vein thrombosis 2