title: Alterations in coagulatory and fibrinolytic systems following an ultra-marathon.
abstract: OBJECTIVE
  The aim of this study was to examine coagulatory and fibrinolytic responses to the Western States Endurance Run (WSER, June 23 to 24, 2012). The WSER is a 161-km (100 mile) trail foot race through the Sierra Nevada Mountains that involves 6,030 m of climb and 7,001 m of descent.
  
  
  METHODS
  We examined 12 men and 4 women [mean (95 % CI), age 44.6 years (38.7-50.6)] who completed the race (24.64 h; range 16.89-29.46). Blood samples were collected the morning before the race, immediately post-race, and 1 (D1) and 2 (D2) days post-race (corresponding to 51-54 h and 75-78 h from the start of the race, respectively). Hypercoagulable state was characterized by prothrombin fragment 1+2 (PTF 1+2) and thrombin-antithrombin complex (TAT). Fibrinolytic state was assessed by plasminogen activator inhibitor antigen (PAI-1 Ag), tissue plasminogen activator antigen (tPA Ag), and D-Dimer. Muscle damage was assessed by serum creatine kinase (CK) and myoglobin concentrations.
  
  
  RESULTS
  Significant (P ≤ 0.05) increases were observed immediately post-race for thrombin generation markers, PTF 1+2 (3.9-fold) and TAT (2.4-fold); markers of fibrinolysis, tPA Ag (4.0-fold), PAI-1 Ag (4.5-fold), and D-Dimer (2.2-fold); and muscle damage markers, CK (154-fold) and myoglobin (114-fold). Most markers continued to be elevated at D1, as seen by PTF 1+2, TAT (1.5- and 1.3-fold increase at D1), and D-Dimer (2.5- and 2.1-fold increase at D1 and D2, respectively). Additionally, PTF 1+2:tPA and TAT:tPA ratios, which assessed balance between coagulation and fibrinolysis, were slightly, but significantly increased at D1 (69 and 36 %) and D2 (19 and 31 %). CK and myoglobin also remained elevated at D1 (54- and 7-fold) and D2 (25- and 2-fold) time points.
  
  
  CONCLUSIONS
  The WSER produced extensive muscle damage and activated the coagulation and fibrinolytic systems. Since we observed a slight imbalance response between the two systems, a limited potential for thrombotic episodes is apparent in these highly trained athletes.
authors: Human Performance Laboratory, Department of Kinesiology, University of Connecticut, Storrs, CT, USA, brian.kupchak@gmail.com.
authors: Brian R
authors: BR
authors: Kupchak
authors: Brittanie M
authors: BM
authors: Volk
authors: Laura J
authors: LJ
authors: Kunces
authors: William J
authors: WJ
authors: Kraemer
authors: Martin D
authors: MD
authors: Hoffman
authors: Stephen D
authors: SD
authors: Phinney
authors: Jeff S
authors: JS
authors: Volek
mesh_terms: D000328:Adult; D000531:Altitude; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009211:Myoglobin / Q000097:blood; D010807:Physical Endurance / Q000502:physiology; D015849:Plasminogen Inactivators / Q000097:blood; D011516:Prothrombin / Q000032:analysis; D012420:Running / Q000502:physiology*; D013917:Thrombin / Q000032:analysis
chemical_list: D009211:Myoglobin; D015849:Plasminogen Inactivators; D011516:Prothrombin; D003402:Creatine Kinase; D013917:Thrombin
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