title: Whole blood coagulation and platelet activation in the athlete: a comparison of marathon, triathlon and long distance cycling.
abstract: BACKGROUND
  Serious thrombembolic events occur in otherwise healthy marathon athletes during competition. We tested the hypothesis that during heavy endurance sports coagulation and platelets are activated depending on the type of endurance sport with respect to its running fraction.
  
  
  METHODS
  68 healthy athletes participating in marathon (MAR, running 42 km, n = 24), triathlon (TRI, swimming 2.5 km + cycling 90 km + running 21 km, n = 22), and long distance cycling (CYC, 151 km, n = 22) were included in the study. Blood samples were taken before and immediately after completion of competition to perform rotational thrombelastometry. We assessed coagulation time (CT), maximum clot firmness (MCF) after intrinsically activation and fibrin polymerization (FIBTEM). Furthermore, platelet aggregation was tested after activation with ADP and thrombin activating peptide 6 (TRAP) by using multiple platelet function analyzer.
  
  
  RESULTS
  Complete data sets were obtained in 58 athletes (MAR: n = 20, TRI: n = 19, CYC: n = 19). CT significantly decreased in all groups (MAR -9.9%, TRI -8.3%, CYC -7.4%) without differences between groups. In parallel, MCF (MAR +7.4%, TRI +6.1%, CYC +8.3%) and fibrin polymerization (MAR +14.7%, TRI +6.1%, CYC +8.3%) were significantly increased in all groups. However, platelets were only activated during MAR and TRI as indicated by increased AUC during TRAP-activation (MAR +15.8%) and increased AUC during ADP-activation in MAR (+50.3%) and TRI (+57.5%).
  
  
  CONCLUSIONS
  While coagulation is activated during physical activity irrespective of type we observed significant platelet activation only during marathon and to a lesser extent during triathlon. We speculate that prolonged running may increase platelet activity, possibly, due to mechanical alteration. Thus, particularly prolonged running may increase the risk of thrombembolic incidents in running athletes.
authors.affiliation: Klinik für Anästhesiologie, Klinikum der Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany. Alexander.Hanke@med.uni-duesseldorf.de
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Hanke
authors.forename: A
authors.initials: A
authors.lastname: Staib
authors.forename: K
authors.initials: K
authors.lastname: Görlinger
authors.forename: M
authors.initials: M
authors.lastname: Perrey
authors.forename: D
authors.initials: D
authors.lastname: Dirkmann
authors.forename: P
authors.initials: P
authors.lastname: Kienbaum
mesh_terms: D000244:Adenosine Diphosphate / Q000494:pharmacology; D000328:Adult; D056352:Athletes; D001642:Bicycling / Q000502:physiology*; D001777:Blood Coagulation / Q000502:physiology*; D006801:Humans; D008297:Male; D015539:Platelet Activation / Q000187:drug effects / Q000502:physiology*; D018179:Receptors, Thrombin; D012420:Running / Q000502:physiology*; D013550:Swimming / Q000502:physiology*; D014914:Whole Blood Coagulation Time
chemical_list: D018179:Receptors, Thrombin; D000244:Adenosine Diphosphate
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