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Comparative Study
. 2010 Feb 26;15(2):59-65.
doi: 10.1186/2047-783x-15-2-59.

Whole Blood Coagulation and Platelet Activation in the Athlete: A Comparison of Marathon, Triathlon and Long Distance Cycling

Free PMC article
Comparative Study

Whole Blood Coagulation and Platelet Activation in the Athlete: A Comparison of Marathon, Triathlon and Long Distance Cycling

Alexander A Hanke et al. Eur J Med Res. .
Free PMC article


Introduction: 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.

Materials and 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%).

Discussion: 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.


Figure 1
Figure 1
Results of rotational thrombelastometry after intrinsically activation before and after competition. Maximum clot firmness (MCF) significantly increased in all groups (left panel). Clotting times (CT) significantly decreased in all groups (right panel). * p < 0.05.
Figure 2
Figure 2
Maximum clot firmness in fibrin polymerization before and after competition as assessed by rotational thrombelastometry (FIBTEM assay). Results significantly increased in all groups. * p < 0.05.
Figure 3
Figure 3
Results of platelet aggregation after stimulation by adenosine-di-phosphat (ADP, left panel) and thrombin activating peptide 6 (TRAP, right panel) as assessed by multiple platelet function analysis before and after competition. Note, that significant increases between pre and post competition (* p < 0.05t) are found in marathon after ADP and TRAP activation and in triathlon after ADP activation only, indicating that platelet activation during prolonged activity is dependent on its running fraction.

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    1. Chan KL, Davies RA, Chambers RJ. Coronary thrombosis and subsequent lysis after a marathon. J Am Coll Cardiol. 1984;4:1322–1325. doi: 10.1016/S0735-1097(84)80157-6. - DOI - PubMed
    1. Disdier P, Harle, Swiader L, Gambarelli-Mouillac N, Weiller PJ. Retinal vein occlusions in a marathon runner. Presse Med. 1992;21:582. - PubMed
    1. Gaudard A, Varlet-Marie E, Monnier JF. et al. Exercise-induced central retinal vein thrombosis: possible involvement of hemorheological disturbances. A case report. Clin Hemorheol Microcirc. 2002;27:115–122. - PubMed
    1. Scobie BA. Gastrointestinal emergencies with marathon-type running: omental infarction with pancreatitis and liver failure with portal vein thrombosis. N Z Med J. 1998;111:211–212. - PubMed
    1. Thompson GR. Grand rounds--Hammersmith Hospital. Hazards of running a marathon. BMJ. 1997;314:1023–1025. doi: 10.1136/bmj.314.7086.1023. - DOI - PMC - PubMed

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