According to the Associated Press' Tim Reynolds, Miami Heat All-Star forward Chris Bosh is dealing with a second episode of blood clots.

The good news is his life is not currently at risk. The bad news is his basketball career could be.

The Vertical's Adrian Wojnarowski reported that Bosh is expected to meet with his doctors Thursday.

At last year’s All-Star break, Bosh was sidelined with blood clots that had traveled to his lungs. That is a much different situation than the current reported calf blood clot. The worry is this clot may progress to his thigh and/or pelvis, then travel to his lungs again.

I don’t pretend to know all the details about Bosh’s medical condition. I am not treating—nor have I examined—Bosh. I am a sports medicine orthopedist, not a pulmonologist or hematologist. However, I do have extensive professional team physician experience that includes time with NBA teams.

The recurrence of deep vein thrombosis (DVT) is worrisome, to be sure. Fortunately, Bosh was tested during last year’s episode and does not have a hypercoagulable condition, where his blood is prone to forming clots.

Otherwise, his NBA career might have already ended.

Similar to—but Different from—Last Season

Blood clots in the legs are often asymptomatic and present with lower-extremity swelling or soreness. Bosh sat out this year’s All-Star Weekend thinking it might be a calf strain. It turned out to be a calf DVT.

Lung clots can cause breathing difficulty, and that led to Bosh being evaluated last year.

In 2015, Bosh needed high levels of anticoagulation therapy to prevent further lung issues and help dissolve the clots already formed. The risks were clear: increased chances of bleeding, a risk of dislodging more clots and difficulty breathing. He was wisely ruled out for the rest of the season.

He was cleared to play this year, because after his initial treatment, only aspirin (lowest form of blood thinner) was needed. But recurrence is not uncommon. There is often internal damage to the vein that makes it likelier for DVT to form.

Other risk factors for Bosh include his 6'11" height (more difficult circulation) and long plane flights, which lead to long periods of inactivity. This is usually counteracted with compression stockings and frequent movement or walks during plane flights.

If there is risk of the calf clot spreading, high levels of blood thinners may rule Bosh out for the rest of the season.

If he needs high levels of blood thinners permanently, his professional basketball career could be in jeopardy.

Outlook

Typically, any activity with risk of bleeding is discouraged if on anticoagulants. At next week’s NFL Scouting Combine, if a college player is found to need long-term blood thinners, most clubs would rule him out of the draft.

Football certainly has higher risk as a collision sport, but basketball is still deemed a contact sport and has some risk.

If Bosh were to suffer a significant injury that involves bleeding, the effects of any blood thinners would be difficult to reverse quickly.

Coumadin (warfarin) is the gold standard for long-term anticoagulation, but it requires blood monitoring and dietary restrictions similar to those of a diabetic on insulin. There are many new medications including Xarelto, which Bosh has promoted in national commercials, that are easier to use. 

An “umbrella” (inferior vena cava filter) could also be inserted to protect the lung.

Now that the initial aspirin regimen has failed, Bosh will likely need permanent anticoagulation medicine. If he needs only low-level blood thinners, is willing to accept some risk and undergo close monitoring, his NBA career could continue soon.

If he has or risks more lung clots and requires higher levels of medication, basketball becomes a dangerous proposition.

Taking blood thinners should not affect his energy, performance or endurance. If he takes some of the newer medications, he would not even need regular blood testing or have dietary restrictions of foods high in vitamin K.

Assuming Bosh could return on blood thinners, his playing time and training would not need to be decreased. In fact, activity is preventative of DVT.

Overall, if the clot remains only in his calf, Bosh’s career is unlikely to be over.

If the clot travels to the lungs again, that may be a different story. Pulmonary embolus (extensive lung blood clots) is potentially fatal, with up to 100,000 Americans dying each year and nearly a million affected, according to the Centers for Disease Control and Prevention.

I am sure Bosh and his physicians will make the right decision.