More hockey players being diagnosed with blood clots than ever

The doctor told Tomas Fleischmann he may never play hockey again. Blood clots that began in his leg had moved to his lungs and threatened not only his career but his life.

Goaltender Tomas Vokoun's left leg was 10 centimetres bigger than his right because of a clot. Surgery was required to drain the blood and he never played another NHL game.

A week after NBA star Chris Bosh's season ended because of blood clots, Kimmo Timonen is on the verge of returning after his own diagnosis over the summer at home in Finland.

Reasons vary, but with better awareness of the problem, more athletes are being diagnosed with and treated for blood clots than in the past.

"It's getting more common," said Fleischmann, a Florida Panthers forward who has now played almost four years since clots were found in his lungs. "I think it's one thing you've got to be watching and be careful about in the hockey world right now."

Hockey's history of blood clots in players' legs (deep-vein thrombosis) and lungs (pulmonary embolism) goes back 80 years to when Montreal Canadiens great Howie Morenz died of complications from a fractured leg when he crashed into the boards. Former Toronto Maple Leafs defenceman Dmitri Yushkevich had his career cut short because of thrombosis in the early 2000s and Jed Ortmeyer play through his clotting disorder and reached 345 NHL games.

Since Fleischmann's 2011 diagnosis of a clot in both lungs, Vokoun, Timonen, and Pascal Dupuis of the Pittsburgh Penguins have missed time with similar issues. Vokoun had a genetic condition that worsened with travel, Timonen had a blocked shot combined with a hereditary blood disorder keep him off the ice while Dupuis had to stop playing after complications from major knee surgery led to clotting in his lungs.

During his time off, Timonen — who on Friday night was traded from the Philadelphia Flyers to the Chicago Blackhawks — spoke with Fleischmann about how to manage life with blood clots and researched the causes and risks of his condition.

"Somebody called me Dr. Timonen," the 39-year-old defenceman said Wednesday in Toronto as he worked to get ready to make his season debut. "The minimum was six months to be on blood thinners, and obviously I have a lot of time to really do some researching and see what's the deal with it and how you deal moving forward."

No evidence suggests athletes more likely to suffer clots

There's no substantial evidence to suggest athletes, especially in a contact sport like hockey, are more likely to suffer blood clots than other people, according to Dr. William Geerts of Sunnybrook Health Sciences Centre in Toronto. With one out of every 1,000 people getting a clot each year, it's not more prevalent in hockey players, but Geerts said trauma from injuries could play a factor.

"It's possible that really intense athletic activity could induce some clotting," he said. "In many people there are risk factors that would apply to all of us.

"So if I break my ankle, then I could get a blood clot, too, just like an athlete could."

While Dupuis remains out with what Penguins team physician Dr. Dharmesh Vyas said could have been a life-threatening condition if untreated, deep-vein thrombosis effectively ended Vokoun's career. But hockey wasn't on Vokoun's mind when it first happened.

"I was worried about being able to live a normal life and actually enjoy all the things I have a chance to enjoy now: retirement and being with my family and all that," he said in a telephone interview from his south Florida home.

Like Vokoun, Timonen's quality of life in retirement is expected to be fine, though he said he'll be on some type of blood thinners like he had for the past several months. With bleeding being a major immediate concern in returning, Timonen is now off blood thinners, also known as anticoagulants.

"In a sport like hockey where you can get banged around quite a bit and players get bruises and stuff, if you're on anticoagulants, the bleeding could be a lot more significant," Geerts said. "If you hit your head on the ice and you're not on anticoagulants, you could have a little bruise on the brain.

"If you're on anticoagulants and you hit your head on the ice to the same degree, you can have a pretty significant bleed."

Fleischmann gets treatment after practices and games and takes injections to control his condition. He's a source of information and inspiration for Timonen, who said he's simply trying to "retire with my skates on, not my shoes."

Timonen could play as soon as Monday for the Blackhawks against Carolina, marking another success story for a hockey player with blood clots.

"It's great to see him not just coming back to hockey, because obviously he had a great and long career," said Vokoun, who played nine seasons with Timonen in Nashville. "But more importantly being healthy and hopefully being able to enjoy everything his hard effort earned when he's going to be done with the game."