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

Dana Huskens; Mark Roest; Jasper A. Remijn; Joke Konings; Romy M. W. Kremers; Saartje Bloemen; Evelien Schurgers; Anna Selmeczi; Hilde Kelchtermans; Rinaldo van Meel; Steven J. Meex; Marie-Claire Kleinegris; Philip G. de Groot; Rolf T. Urbanus; Marisa Ninivaggi; Bas de Laat

doi:10.1160/TH15-10-0821

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2016; 115(06): 1109-1119
DOI: 10.1160/TH15-10-0821

Coagulation and Fibrinolysis

Schattauer GmbH

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

Dana Huskens^*

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Mark Roest^*

²Synapse BV, Maastricht, The Netherlands

,

Jasper A. Remijn^*

³Department of Clinical Chemistry and Hematology, Gelre Hospitals, Apeldoorn, The Netherlands

,

Joke Konings

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Romy M. W. Kremers

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Saartje Bloemen

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Evelien Schurgers

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Anna Selmeczi

⁴Institute of Medicine, Division of Haemostasis, University of Debrecen, Debrecen, Hungary

,

Hilde Kelchtermans

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Rinaldo van Meel

²Synapse BV, Maastricht, The Netherlands

,

Steven J. Meex

⁶Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands

,

Marie-Claire Kleinegris

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

,

Philip G. de Groot

²Synapse BV, Maastricht, The Netherlands

⁵Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Rolf T. Urbanus

⁵Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

,

Marisa Ninivaggi

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

,

Bas de Laat

¹Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands

²Synapse BV, Maastricht, The Netherlands

⁵Department of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands

› Author Affiliations

Abstract

Summary

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 protour 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 proand 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.

Keywords

Exercise - coagulation - platelets - thrombin - fibrinolysis

Full Text

References

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