The Risk of Blood Clots and Kimmo Timonen’s Uncertain Future

Hockey is a game that forces you to spend years refining your skills. Hockey is a lifeline that’s been entrenched in your genetic makeup since childhood. Hockey is what you’re recognized for and how you put food on the table for your kids. And in an instant, the game you know, love, and understand can be taken away from you.

Yesterday, news broke of defenseman Kimmo Timonen being diagnosed with three different blood clots – one in his right leg and one in each of his lungs. Whenever you hear the term ‘blood clot’ you know it usually isn’t good. I’ve been a fan of Kimmo’s for years now. He’s been a class act his entire career, a warrior on the ice, and a true professional off of it. This year was likely to be his last in the NHL, but with yesterday’s unfortunate discovery, things don’t look promising.

I don’t have a medical degree, I don’t claim to be a doctor by any stretch of the imagination, nor do I know the first thing about blood clots, their affects, and the risks that are associated with them. Luckily for me, a fellow THW writer, Prashanth Iyer, successfully passed pharmacy school at the University of North Carolina and just completed a cardiology rotation in the Cardiac Intensive Care Unit at the UNC Hospital. So why not turn to someone who knows a thing or two about this stuff.

The basic understanding of blood clots is this: clotting occurs naturally in the body when you get a cut or have any other trauma to an organ by sending clotting factors to the site. The issue with blood clots is that too much of these platelets are sent to the site and begin to clump, break off, and float around your vessels. It’s not a serious case until one of the clumps of blood reach a very small blood vessel and begin to clog the passage for blood to get through. Once a clot lodged in a small vein of your leg, it can continue to build as more platelets get stuck to it. Parts of the clot can then break off, travel to the lungs, and cause a pulmonary embolism which can be life-threatening.

In regards to Timonen’s blood clots, he was stricken with two separate kinds. The one his his leg is known as a Deep Vein Thrombosis (DVT). The two he has in his lungs are known as Pulmonary Embolisms (PE). As Prashanth explains:

“The reason clots form in the lower legs involves the size of the vessels that the clot passes through after it leaves the heart. After the blood leaves the heart, it is pumped through arteries and then into veins. As the blood moves farther away from the heart, the vessels that the blood moves through become narrower and narrower. This increases the likelihood that the clot will get lodged in the vessel. Once lodged, the clot can prevent blood from getting around it and cause severe pain in the leg that it is lodged in. The clot can also become larger as more and more blood products get stuck on the clot. The truly severe part occurs if part of the clot becomes dislodged. If part of the clot becomes dislodged, the clot will follow the veins, returning back to the heart where it will then be pumped into the lungs. The clot can become lodged in one of the pulmonary arteries. If this happens, a person will become short of breath, have chest pain, and this can sometimes be fatal.”

It also doesn’t help that Timonen has a pre-existing condition with blood clots.

“In the case of Timonen, he has a genetic condition called Protein C deficiency. Protein C plays a role in regulating blood clotting, so when a person is Protein C deficient, they are at a higher risk for developing these blood clots.”

Think of it like this. Protein C is a natural blood thinner that your body produces. If you have a deficiency in Protein C (like Timonen does), their risk for an abundance of platelets to form increases making them susceptible to blood clots. This isn’t the first time Timonen has gone through this. In 2008, after blocking a shot against Montreal in the playoffs, Timonen sat out four games in the Eastern Conference Finals after suffering a blood clot in his leg.

Philadelphia Flyers - Kimmo Timonen - Photo by Andy Martin Jr
Philadelphia Flyers – Kimmo Timonen – Photo by Andy Martin Jr

Now it’s time to look at the future Timonen has at playing hockey. Ultimately, there is a small amount of light at the end of the title, but will likely dwindle down to a black hole. After someone is diagnosed with two different blood clots, doctors typically place said people on blood thinners for the rest of their lives to prevent blood clots from forming again.

I don’t know the full details of Timonen’s blood clots or how he’s doing, but playing on blood clots could potentially be a death sentence. A hit severe hit to the head, a blocked shot, or anything else that may cause immediate trauma to any part of the body could lead to some very dangerous side effects and possibly death. Iyer further lays out the bleak future Timonen might endure if there is even a slight chance he plays in the NHL:

“Playing hockey while actively treating a blood clot is almost out of the question. After getting through the emergent phase, people will be placed on a medication to thin their blood. The length of treatment with the blood thinner is dictated by how likely the person is to clot again. A person’s clot risk is determined by their clot history, genetics, and lifestyle factors. In the case of Timonen, he has clotted before and has a genetic condition, making the likelihood of him clotting again very high. With Timonen having a high risk of clotting again, he will most likely be placed on a blood thinner for the rest of his life. Playing hockey while on a blood thinner is unfortunately not a realistic expectation. When on a blood thinner, people are at a higher risk for bruising, minor bleeding, and major bleeding. Depending on the blood thinner selected, the bleeding can be incredibly complicated to control. Based on Timonen’s lifestyle and age, he would most likely be placed on a “new oral anticoagulant”. These medications work incredibly well when it comes to treating blood clots, but they have the unfortunate caveat of not being easily reversible. What this means is that if a person were to start bleeding while on one of these medications, it would not be easy to control the bleeding. There is no specific antidote for these medications and medical teams are often forced to try numerous medications in hopes of controlling the bleeding. Between flying pucks, high sticks, and sharp skates, the bleeding risk while playing hockey is simply too high for Timonen to risk playing again. Even if Timonen opted for the blood thinner that has an antidote, he would have to revolutionize his lifestyle. That specific blood thinner, known as Coumadin, requires a person to regulate their diet; specifically how much vitamin K they take in every day. Even the slightest alteration in a person’s vitamin K intake can have disastrous consequences. In addition, Coumadin interacts with a variety of medications, further complicating any future treatment Timonen may require. All in all, the risks of playing hockey while on a blood thinner far outweigh trying to continue his career.”

Ultimately, we will have to see how Timonen progresses going forward, but the prognosis of him ever lacing up the skates again in the NHL is very grim. If I was a betting man, I’d say Kimmo Timonen has played his last game in the NHL, which is extremely unfortunate for the Flyers who were relying on his help this season, and even more unfortunate for Timonen since hockey has been a part of his life since he was a child. But what needs to be done now is for Timonen to rest and get healthy because at this stage, that is what is most important.