March madness-associated deep vein thrombosis.

We describe a case of March madness-associated deep vein thrombosis in a spectator. Review of the literature revealed one previously reported case of pulmonary embolism related to prolonged television viewing. (1)

An 83-year-old male with a history of prostate cancer presented to the emergency room at Walter Reed Army Medical Center after experiencing a presyncopal episode at church during the first weekend of the NCAA basketball tournament. The patient was diagnosed with orthostatic hypotension and was referred for follow-up with his primary care provider the next day. His physician obtained a history of baseline mild chronic bilateral lower extremity edema with increased swelling of the left lower extremity over the past 7 days. The increased edema was first noticed after a full day of sitting and watching college basketball tournament games on television. There was no history of thrombosis, bleeding problems, or trauma to his lower extremity. The patient's medical history was otherwise significant for prostate cancer, which was treated with prostatectomy several years ago. A recent increase in his prostate-specific antigen level suggests a high likelihood of recurrent prostate cancer, as yet asymptomatic, with evaluation in progress. He reported no dyspnea, fever, chest pain, or anxiety. Vital signs were normal. Examination was remarkable for an edematous, nontender left lower extremity with 3+ edema to the mid-thigh. Circumference was 3 cm greater on the left compared with the right. Doppler ultrasonography verified an acute nonocclusive deep vein thrombosis in his left superficial femoral vein. Anticoagulation was initiated.

In this case, we believe that recurrent malignancy placed this individual at increased risk for thrombosis but that prolonged immobility while watching successive basketball games was a significant contributing factor to clot formation.

Patients, especially those with an underlying hypercoagulable state such as activated protein C resistance, malignancy, pregnancy, and antiphospholipid syndrome, are at risk of developing deep vein thrombosis from blood stasis from prolonged immobilization. (2) Although the "March madness" of college basketball provides hours of sustained entertainment, immobilization from watching successive games may contribute to potentially lethal thrombotic events, especially in those with an underlying hypercoagulable state. We recommend that television viewers follow guidelines similar to those for airline travelers: limit alcohol and caffeine intake, liberalize intake of water and other fluids, and stand at regular intervals to stretch and promote circulation. (3)

References

1. de Zwaan C, Janssen JH, Cheriex EC, et al. Watching television and pulmonary embolism. Am J Cardiol 1984; 54:1391-1392.

2. Weinmann EE, Salzman EW. Medical progress: deep-vein thrombosis. N Engl J Med 1994;331:1630-1641.

3. Aerospace Medical Association Medical Guidelines Task Force. Medical Guidelines for Airline Travel, 2nd ed. Aviat Space Environ Med 2003; 74(Suppl 5): A1-A19.

Ramey L. Wilson, MD

Joan B. Ritter, MD

Michael J. Roy, MD, MPH

Walter Reed Army Medical Center

Washington, DC