John,

I presented with a DVT last September after a traumatic bike accident. Prior to the DVT rearing its ugly head I saw a huge downturn of my aerobic fitness. The symptoms of the DVT were very obvious by the time I went to the doctor. A CT scan showed I had hundreds of small and a couple of large emboli in my lungs. The doctors felt that I had been shedding clots for weeks from the DVT that were then being caught in my lungs. I was hospitalized for a couple of days, treated with Lovenox and then transitioned to Xarelto. Since the doctors felt that my DVT was of the "provoked" nature they took me off Xarelto at 3 months. Within days the DVT became apparent again so I was restarted on anticoagulant therapy. I'll be trying to come off again at 6 months from resuming Xarelto. Cut to the chase- I'd be really worried about exercising without anticoagulant therapy unless I was sure my DVT was resolving. Loading your lungs with emboli is a recipe for a stroke or other nasty events. I'd highly recommend seeing a hematologist early on. They see to be more "up to speed" than most doctors.

Good luck,

Hugh

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Genetics load the gun, lifestyle pulls the trigger.

John,

I was wondering if you found any good advice on when it is safe to return to running.

I was diagnosed with DVT a week ago, and I know I've had the symptoms for 2 weeks. I've been on Eliquist and the swelling in my calf has gone down. I go back to my doctor next week, so I will see what he says. He has advised that I take 2 to 3 months off of training.

Hi,

I discussed this with my primary care provider, who had no specific recommendation and did an extensive literature review (I am an academic physician so have excellent medical library access through the medical school). DVT and hematology are not my areas of specialization, but I have enough experience to understand the data--really, there are no data or clear recommendations on returning to rigorous exercise after DVT. Part of the problem is that most DVT studies are in older people or those with medical co-morbidities, not triathletes or runners. There is some data that early mobilization and return to light exercise after DVT reduces incidence of post-DVT syndrome. Based on this, I continued my 1.5 mile easy bike commutes as my "light exercise". The one paper out there that makes a recommendation on return to running is very conservative (6 weeks of followed by very gradual increases), though there is no data supporting that conservative approach. Link to that paper (also a couple of other DVT/VTE papers) follows:

https://www.sportsmed.org/...mbolismResources.pdf

From that first article:

"While data for anticoagulation and early mobilization exist, data guiding return to physical activity are sparse. There are no RCT (randomized clinical trials) investigating when it is safe to return to sport following VTE. There are no expert consensus-derived clinical practice guidelines on the topic."

My clot was isolated to the calf only and was stable on serial ultrasounds, so I did not have to go on chronic anticoagulation, though I did take aspirin for a few weeks. At the time of my final ultrasound, I was three weeks after diagnosis and basically 4 weeks after onset of symptoms. Because I was pain free and the clot was stable and imaging showed that the clot was contracting, I took it upon myself to resume running (3-4 miles easy pace for my first few runs). Within two weeks, I was back up to 30 miles/week, with the major impact being the effects of a month without running. I think it unlikely many doctors (except me) would have recommended that, but as far as I could tell from the published literature, the risk of clot breaking off and causing pulmonary embolism reduces after 4-6 weeks.

I expect that your doctor will be conservative in the recommendations. Being on Eliquis puts you at some risk of bleeding, which is a different situation than I was in.

Good luck in your recovery, I am pleased that your symptoms are improving.

There have been a number of threads on PE and DVT over the past couple of years. I am not a doctor but have had a PE and spent some time in a hospital with doctors looking at me In the way you don't want doctors looking at you.

Mine was unknown cause (probably travel related) and no hereditary causes found. Spent 6 months on warfarin and then clear. No recurrence (knock on wood). I don't remember exactly when I restarted running but I was still on warfarin and my doctor at the time wasn't very happy with me. I simply started by going to the end of my street and back (even this 1/2 mile was really tough) and adding a little bit each day depending on how I felt. Patience was the key for me. At the time, nobody could give me clear guidance on resuming workouts so I went totally be how I felt. THe biggest concern from doctor seemed to be bleeding risk because of the warfarin. I stayed off the bike for quite a while not wanting to risk a crash and bleeding.

Best of luck.

Just experienced a DVT and was put on Xarelto, have seen an increase in resting HR from 50 to 74. While in ER the heart rate sat at my normal range of 48 to 52. Since starting the Xarelto has been going up every day by a couple of beats. Will be reducing the dose next week and will see if it is dose related but wondering about others experience with this????

I imagine it's going up because you're stressed about the situation and undergoing detraining at the moment. Once you begin training again it ought to go back down. I experienced some very unsettling numbness of my calf and bottom of my foot when I began on Xarelto that came and went for several weeks but has now completely subsided. I would recommend you get set up with a hematologist if you haven't already. They seem to be vastly more "up to speed" regarding anticoagulant therapy than GPs and pulmonologists.

Good Luck,

Hugh

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Genetics load the gun, lifestyle pulls the trigger.