Strenuous exercise induces a hyperreactive rebalanced haemostatic state that is more pronounced in men

Abstract

Physical exercise is recommended for a healthy lifestyle. Strenuous exercise, however, may trigger the haemostatic system, increasing the risk of vascular thrombotic events and the incidence of primary cardiac arrest. Our goal was to study the effects of strenuous exercise on risk factors of cardiovascular disease. Blood was collected from 92 healthy volunteers who participated in the amateur version of the pro-tour Amstel Gold cycling race, before and directly after the race. Thrombin generation showed a shortening of the lag time and time to peak and an increase of the velocity index. Interestingly, the endogenous thrombin potential measured in plasma decreased due to reduced prothrombin conversion. Platelet reactivity increased and this effect was stronger in men than in women. Lower fibrinogen and higher D-dimer levels after exercise indicated higher fibrin formation. On the other hand, fibrinolysis was also elevated as indicated by a shortening of the clot lysis time. Exercise activated the endothelium (von Willebrand factor (VWF) and active VWF levels were elevated) and the immune system (concentrations IL-6, IL-8, MCP-1, RANTES and PDGF increased). Additionally, an increased cardiac troponin T level was measured post-exercise. Strenuous exercise induces a temporary hyperreactive state in the body with enhanced pro- and anticoagulant responses. As strenuous exercise has a more pronounced effect on platelet function in male subjects, this gives a possible explanation for the higher incidence of sudden cardiac death during exercise compared to women. This trial is registered at www.clinicaltrials.gov as NCT02048462.

Deciphering the coagulation profile through the dynamics of thrombin activity

“…Even though the thrombin dynamics method has shown its added value to thrombin generation data in several clinical studies in the past years, the meaning of each parameter in the wider context of coagulation has yet to be investigated [14][15][16][17][18][19][20][21][22] . In this study, we investigated the effect of four major coagulation factors (prothrombin, FV, FX, and antithrombin) on five thrombin dynamics parameters (PC tot , PC max , T-AT, T-α 2 M, and TDC).…”

“…The dynamics of thrombin generation have been studied in multiple clinical settings over the past years to study the balance between pro-and anticoagulant mechanisms, and to perform in silico experimentation to generate hypotheses [14][15][16][17][18][19][20][21][22] . Recently, questions have started to emerge about the influence of individual coagulation factor levels on the parameters of prothrombin conversion and thrombin inactivation.…”

Pro-coagulant activity during exercise testing in patients with coronary artery disease

“…The borderline significant increased levels of D-dimer might also be discussed as part of the acute phase response. Several previous studies have established that healthy, well-trained individuals have lower ETP levels and higher F1 + 2 levels than untrained subjects [28–30]. This has partly been explained by a decrease of ex vivo thrombin generation in the presence of decreasing amounts of prothrombin by its conversion to thrombin in vivo, potentially an exhaustion phenomenon [31].…”

Fasciola hepatica serine protease inhibitor family (serpins): Purposely crafted for regulating host proteases

“…Calibrated automated thrombography (CAT) was used to assess the interaction of the F. hepatica serpins with coagulation factors II, V, VII, VIII, IX, X and XI as per the protocol used by Huskens et al [40]. Thrombin generation was tested in triplicate in the presence or absence of rFhSrp1 and rFhSrp2, which were added in varying concentrations (12.5 to 50 μg/mL).…”