The Science Behind Jalen Hurts’ Controversial Blood Clot Diagnosis Is More Complicated Than It Looks

4 min readEver since it was announced that Philadelphia Eagles quarterback Jalen Hurts’ season was over due to a blood clot diagnosis, everybody has developed an opinion on how the situation could have been handled better. But despite what you might think, it turns out that it’s more complex than your uncle with no medical training and a debilitating sports betting addiction is able to grapple with at first blush.Over the weekend, it was announced that the NFL and the NFL Players Association would be launching a review of how the diagnosis was handled, after the NFLPA made a call for an investigation last week.Hurts was sidelined after a blood clot in his left calf traveled to his lungs. The Eagles announced that Hurts had “deep vein thrombosis and bilateral pulmonary emboli,” a condition which required blood thinners as part of the treatment. Hurts cannot participate in any “football activities” until he is no longer on them.The issue at hand is the timeline of the diagnosis. Initially, after Hurts suffered a “cleating” injury in his calf on October 4 in a game against the Los Angeles Rams, doctors in London (where the Eagles were set to play the Jacksonville Jaguars on October 11) performed an ultrasound and diagnosed Hurts with “superficial vein thrombosis.” Despite the clotting, he would go on to play against the Jaguars, completing 21 of 40 passes for 220 yards and one touchdown.It was only after he returned home to the United States that the clot’s movement was discovered, and he was re-diagnosed with deep vein thrombosis.The distinction is important, as superficial vein thrombosis involves clots in veins close to the skin surface, and pose minimal risk of traveling to the lungs, but deep vein thrombosis poses a far greater risk of a pulmonary embolism, which could be life-threatening. The question at the core of this uproar is whether doctors in London missed some key signs from the ultrasound in making the initial diagnosis, allowing Hurts to play in a game he wouldn’t have played in if there was a DVT diagnosis, or whether his condition simply worsened from that initial ultrasound.Dr. Chuck Dinerstein, a vascular surgeon, published a piece for the American Council on Science and Health, before the NFL and NFLPA made their decision to review the diagnosis. In it, he addressed the diagnosis question and the blame game that immediately followed, stressing that “as a vascular surgeon, I know a bad outcome doesn't necessarily mean someone made a bad call.“Taking all the opinions into account,” Dinerstein says, “the NFL and the Eagles left one question unanswered: what the exact findings were at the time of the initial venous ultrasound.”“Our description of the leg veins contains an oddity,” he notes. “The superficial femoral vein is, in fact, deep and a source of pulmonary emboli. For the most part, we have changed the language used to describe these veins as the femoral vein, but I am not sure whether the British report used that language, nor do I know whether the treating physician reviewed the ultrasound with the radiologist.”To date, we do not have this sensitive medical information. Hurts’ medical records, Dinerstein notes, are “his to disclose, not ours to demand.” The forthcoming NFL and NFLPA review may, however, provide greater clarity on that front.It may also answer another question, namely if those initially identified superficial clots “went on to propagate deeper clots that ultimately were the source of his pulmonary embolisms.”Dinerstein cites the CALISTO study, an abbreviation for Comparison of Arixtra in Lower Limb Superficial Vein Thrombosis With Placebo, which as the name suggests examined the efficacy of anticoagulants vs. placebos in cases of superficial venous clots. Comparing the effects of anticoagulants vs. placebos, the study found “pulmonary embolism in 0% versus 0.3%” and “deep-vein thrombosis in 0.2% versus 1.2%.”“With these facts in hand,” Dinerstein notes, “physicians presumably counseled Mr. Hurts.”No one, he argues, would have let Hurts play football while on an anticoagulant, due to the risk of a “serious bleed.” So, he suggests, a decision was made regarding whether Hurts could continue to play in spite of the “small risk” of developing DVT or a pulmonary embolism. “ That is a judgment call, and only Mr. Hurts and his physicians can tell us about that conversation.”Dinerstein concludes by noting the importance of differentiating between accountability and blame. When a complication like Hurts’ arises, “it is both tempting and necessary to work backward from the outcome to identify the moment someone might have made a mistake. But that is not how medical decisions are made.”“Shared medical decision-making does not guarantee a good outcome;” he argues, “it provides a framework for choosing among imperfect options.”Accountability, he suggests “requires knowing what those decisions were and the circumstances in which they were made.” Perhaps this new review may shed light on just how those decisions.Until we have that information, though, the assessment of that aforementioned angry sports-betting uncle should probably be ignored.Honestly, even after we have all the facts, you might do well to just treat that uncle’s opinions with a grain of salt anyway, but we digress.Michale Natale is a News Editor for the Hearst Enthusiast Group. As a writer and researcher, he has produced written and audio-visual content for more than fifteen years, spanning historical periods from the dawn of early man to the Golden Age of Hollywood. His stories for the Enthusiast Group have involved coordinating with organizations like the National Parks Service and the Secret Service, and travelling to notable historical sites and archaeological digs, from excavations of America’ earliest colonies to the former homes of Edgar Allan Poe.