I have been fascinated by the discussion of whether Miami Heat forward Chris Bosh would return to play in the NBA postseason after missing the last few months reportedly dealing with a recurrence of blood clots. The story has both a “play now” vs. “long-term health” aspect as well Basketball through netas a player’s wishes vs. those of the team. I am no expert on deep vein thrombosis, or blood clots in the veins of the legs, so I interviewed a primary care sports medicine physician about the subject for my latest newspaper column.

Is the medical risk of playing basketball after suffering a blood clot too high?

Apparently the Miami Heat think so. Last week, the team announced that its All-Star forward Chris Bosh would miss the rest of the postseason. Bosh has been sidelined since February 9 with blood clot in his calf.

Chris Bosh and the pulmonary embolism in his lungs

The blood clot that ended his current season followed a similar, but scarier, episode last season. On a vacation in Haiti shortly after the All-Star game, Bosh felt sharp chest pains. He was admitted to a Miami hospital, where doctors found a pulmonary embolism. This is a potentially life-threatening clot in the lungs that often originates in the veins of the leg. Bosh required months of blood-thinning medications and missed the rest of the 2015 season.

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Bosh’s desire to play despite a second blood clot

This March, amid concerns throughout the league about the recurrence of his blood clot, Bosh released a statement claiming he felt positive that he would return this season. He explained that the “situation this year has never been life-threatening” and that he was working with the team on precautionary treatments.

According to Ethan J. Skolnick and Barry Jackson of the Miami Herald, Bosh sought medical opinions outside of the Heat’s medical staff. His doctors had different opinions on whether it was safe to stop taking blood thinners in order to play.

The dangers of playing sports on blood-thinning medicationsMan holding basketball

Dr. Andy McMarlin, a primary care sports medicine physician at Winning Health in Mount Pleasant, South Carolina, explained the danger for an athlete taking these medications.

“The big risk would be if you had an impact to your head,” Dr. McMarlin reasoned. While there is some risk with cuts, or chest or abdominal impacts, the real concern is intracranial hemorrhage. In the NBA, big men approach 7 feet and weigh well over 200 pounds. An elbow to the head from a defender could cause a serious problem for an athlete taking blood thinners.

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McMarlin has a couple of patients on blood thinning medications who are participating in low-impact sports, like surfing and golf. He agrees with the concern for athletes playing contact sports, however. He recognizes that concussions can occur in basketball, especially when an athlete jumps, his legs are taken out from under him and he hits his head on the floor.

Should Chris Bosh be allowed to play on blood thinners?

Bosh’s medical dilemma differs from what we often hear in professional sports, where a team wants a top player on the field or court in order to win, even at the expense of his long-term health. In this case, we have a player who wants to play and his team could certainly use him, but the medical staff and management are taking the cautious route.

The Heat reportedly would not let Bosh play even if he was cleared by an outside physician or if he signed a waiver that limited the team’s liability, according to Skolnick and Jackson.

Reporters covering the NBA have speculated that if doctors determine his case to be career-ending, the Heat could look to get some of the roughly $75 million they must pay him over the next three seasons off of their salary cap numbers.
Bosh has reportedly denied claims he would retire, insisting he will play for the team next season.

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The Heat might also have a justified concern of liability should a serious medical event occur while Bosh plays. Head coach Erik Spoelstra played for the University of Portland iBasketball on hoopn the West Coast Conference tournament semifinal game in 1990. Spoelstra was on the floor when Loyola Marymount star Hank Gathers collapsed and died after a sudden cardiac arrest.

Now with a second season shortened due to blood clots, NBA fans wait to see if blood clots ultimately end Chris Bosh’s career.

What should a professional team do if one of its athletes suffers blood clots and needs blood-thinning medications? What should the athlete do? Share your thoughts below!

Note: A modified version of this article appears as my sports medicine column in the May 11, 2016 issue of The Post and Courier.

Heat rightly play it safe with Bosh. By Sean Highkin. Sports on Earth. May 5, 2016.

Chris Bosh travels with Heat, but still out indefinitely amid secrecy. BY Ethan J. Skolnick and Barry Jackson. The Miami Herald. April 23, 2016.

Chris Bosh ready to breathe new life into Heat. By Lee Jenkins. SI.com. September 24, 2015.