title: Blood coagulation activation and fibrinolysis during a downhill marathon run.
abstract: Prolonged physical exercise is associated with multiple changes in blood hemostasis. Eccentric muscle activation induces microtrauma of skeletal muscles, inducing an inflammatory response. Since there is a link between inflammation and coagulation we speculated that downhill running strongly activates the coagulation system. Thirteen volunteers participated in the Tyrolean Speed Marathon (42,195 m downhill race, 795 m vertical distance). Venous blood was collected 3 days (T1) and 3 h (T2) before the run, within 30 min after finishing (T3) and 1 day thereafter (T4). We measured the following key parameters: creatine kinase, myoglobin, thrombin-antithrombin complex, prothrombin fragment F1 + 2, D-dimer, plasmin-alpha(2)-antiplasmin complexes, tissue-type plasminogen activator antigen, plasminogen-activator-inhibitor-1 antigen and thrombelastography with ROTEM [intrinsic pathway (InTEM) clotting time, clot formation time, maximum clot firmness, alpha angle]. Thrombin generation was evaluated by the Thrombin Dynamic Test and the Technothrombin TGA test. Creatine kinase and myoglobin were elevated at T3 and further increased at T4. Thrombin-antithrombin complex, prothrombin fragment F1 + 2, D-dimer, plasmin-alpha(2)-antiplasmin complexes, tissue-type plasminogen activator antigen and plasminogen-activator-inhibitor-1 antigen were significantly increased at T3. ROTEM analysis exhibited a shortening of InTEM clotting time and clot formation time after the marathon, and an increase in InTEM maximum clot firmness and alpha angle. Changes in TGA were indicative for thrombin generation after the marathon. We demonstrated that a downhill marathon induces an activation of coagulation, as measured by specific parameters for coagulation, ROTEM and thrombin generation assays. These changes were paralleled by an activation of fibrinolysis indicating a preserved hemostatic balance.
authors.affiliation: Division for General and Surgical Intensive Care Medicine, Clinic for Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria.
authors.forename: Günther
authors.initials: G
authors.lastname: Sumann
authors.forename: Dietmar
authors.initials: D
authors.lastname: Fries
authors.forename: Andrea
authors.initials: A
authors.lastname: Griesmacher
authors.forename: Gerda
authors.initials: G
authors.lastname: Falkensammer
authors.forename: Anton
authors.initials: A
authors.lastname: Klingler
authors.forename: Arnold
authors.initials: A
authors.lastname: Koller
authors.forename: Werner
authors.initials: W
authors.lastname: Streif
authors.forename: Sven
authors.initials: S
authors.lastname: Greie
authors.forename: Beatrix
authors.initials: B
authors.lastname: Schobersberger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schobersberger
mesh_terms: D001777:Blood Coagulation / Q000502:physiology*; D001780:Blood Coagulation Tests; D001798:Blood Proteins / Q000032:analysis; D005260:Female; D005342:Fibrinolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D012420:Running / Q000502:physiology*
chemical_list: D001798:Blood Proteins