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. 2003 Oct;37(5):433–435. doi: 10.1136/bjsm.37.5.433

Effects of strenuous exercise on haemostasis

J Smith 1
PMCID: PMC1751362  PMID: 14514536

Abstract

Objectives: To review the effects of exercise on haemostasis and examine the possible clinical sequelae of these changes.

Methods: The search strategy included articles from 1966 to August 2002 using Medline and SportDiscus databases, and cross referencing the bibliographies of relevant papers.

Results: Exercise results in activation of both the coagulation and fibrinolytic cascades, as shown by a reduction in whole blood clotting time and activated partial thromboplastin time, an increase in the activity of several components of the cascades, and an increase in fibrin degradation products. In vitro tests suggest that coagulation remains activated after fibrinolysis has returned to baseline levels.

Conclusions: Both the coagulation and fibrinolytic cascades are stimulated by strenuous exercise, but the temporal relation between the two and its clinical significance remains to be clarified. Doctors and athletes should be aware of the haemostatic changes induced by exercise, and further work is needed to clarify the possible role of these changes in sudden cardiac death.

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Selected References

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  1. Albert C. M., Mittleman M. A., Chae C. U., Lee I. M., Hennekens C. H., Manson J. E. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000 Nov 9;343(19):1355–1361. doi: 10.1056/NEJM200011093431902. [DOI] [PubMed] [Google Scholar]
  2. Andrew M., Carter C., O'Brodovich H., Heigenhauser G. Increases in factor VIII complex and fibrinolytic activity are dependent on exercise intensity. J Appl Physiol (1985) 1986 Jun;60(6):1917–1922. doi: 10.1152/jappl.1986.60.6.1917. [DOI] [PubMed] [Google Scholar]
  3. Arai M., Yorifuji H., Ikematsu S., Nagasawa H., Fujimaki M., Fukutake K., Katsumura T., Ishii T., Iwane H. Influences of strenuous exercise (triathlon) on blood coagulation and fibrinolytic system. Thromb Res. 1990 Feb 1;57(3):465–471. doi: 10.1016/0049-3848(90)90262-b. [DOI] [PubMed] [Google Scholar]
  4. Berkarda B., Akokan G., Derman U. Fibrinolytic response to physical exercise in males. Atherosclerosis. 1971 Jan-Feb;13(1):85–91. doi: 10.1016/0021-9150(71)90009-8. [DOI] [PubMed] [Google Scholar]
  5. Bourey R. E., Santoro S. A. Interactions of exercise, coagulation, platelets, and fibrinolysis--a brief review. Med Sci Sports Exerc. 1988 Oct;20(5):439–446. [PubMed] [Google Scholar]
  6. Brown J. E., Baugh R. F., Hougie C. Effect of exercise on the factor VIII complex: a correlation of the Von Willebrand antigen and factor VIII coagulant antigen increase. Thromb Res. 1979;15(1-2):61–67. doi: 10.1016/0049-3848(79)90052-5. [DOI] [PubMed] [Google Scholar]
  7. Bärtsch P., Haeberli A., Straub P. W. Blood coagulation after long distance running: antithrombin III prevents fibrin formation. Thromb Haemost. 1990 Jun 28;63(3):430–434. [PubMed] [Google Scholar]
  8. Bärtsch P., Schmidt E. K., Straub P. W. Fibrinopeptide A after strenuous physical exercise at high altitude. J Appl Physiol Respir Environ Exerc Physiol. 1982 Jul;53(1):40–43. doi: 10.1152/jappl.1982.53.1.40. [DOI] [PubMed] [Google Scholar]
  9. Bärtsch P., Welsch B., Albert M., Friedmann B., Levi M., Kruithof E. K. Balanced activation of coagulation and fibrinolysis after a 2-h triathlon. Med Sci Sports Exerc. 1995 Nov;27(11):1465–1470. [PubMed] [Google Scholar]
  10. Cohen R. J., Epstein S. E., Cohen L. S., Dennis L. H. Alterations of fibrinolysis and blood coagulation induced by exercise, and the role of beta-adrenergic-receptor stimulation. Lancet. 1968 Dec 14;2(7581):1264–1266. doi: 10.1016/s0140-6736(68)91760-1. [DOI] [PubMed] [Google Scholar]
  11. Collen D., Semeraro N., Tricot J. P., Vermylen J. Turnover of fibrinogen, plasminogen, and prothrombin during exercise in man. J Appl Physiol Respir Environ Exerc Physiol. 1977 Jun;42(6):865–873. doi: 10.1152/jappl.1977.42.6.865. [DOI] [PubMed] [Google Scholar]
  12. Collen D., Semeraro N., Tricot J. P., Vermylen J. Turnover of fibrinogen, plasminogen, and prothrombin during exercise in man. J Appl Physiol Respir Environ Exerc Physiol. 1977 Jun;42(6):865–873. doi: 10.1152/jappl.1977.42.6.865. [DOI] [PubMed] [Google Scholar]
  13. Davis G. L., Abildgaard C. F., Bernauer E. M., Britton M. Fibrinolytic and hemostatic changes during and after maximal exercise in males. J Appl Physiol. 1976 Mar;40(3):287–292. doi: 10.1152/jappl.1976.40.3.287. [DOI] [PubMed] [Google Scholar]
  14. De Paz J. A., Lasierra J., Villa J. G., Viladés E., Martín-Nuño M. A., González-Gallego J. Changes in the fibrinolytic system associated with physical conditioning. Eur J Appl Physiol Occup Physiol. 1992;65(5):388–393. doi: 10.1007/BF00243502. [DOI] [PubMed] [Google Scholar]
  15. El-Sayed M. S., Jones P. G., Sale C. Exercise induces a change in plasma fibrinogen concentration: fact or fiction? Thromb Res. 1999 Dec 15;96(6):467–472. doi: 10.1016/s0049-3848(99)00140-1. [DOI] [PubMed] [Google Scholar]
  16. El-Sayed M. S., Lin X., Rattu A. J. Blood coagulation and fibrinolysis at rest and in response to maximal exercise before and after a physical conditioning programme. Blood Coagul Fibrinolysis. 1995 Dec;6(8):747–752. doi: 10.1097/00001721-199512000-00009. [DOI] [PubMed] [Google Scholar]
  17. Ferguson E. W., Barr C. F., Bernier L. L. Fibrinogenolysis and fibrinolysis with strenuous exercise. J Appl Physiol Respir Environ Exerc Physiol. 1979 Dec;47(6):1157–1161. doi: 10.1152/jappl.1979.47.6.1157. [DOI] [PubMed] [Google Scholar]
  18. Ferguson E. W., Bernier L. L., Banta G. R., Yu-Yahiro J., Schoomaker E. B. Effects of exercise and conditioning on clotting and fibrinolytic activity in men. J Appl Physiol (1985) 1987 Apr;62(4):1416–1421. doi: 10.1152/jappl.1987.62.4.1416. [DOI] [PubMed] [Google Scholar]
  19. Ferguson E. W., Guest M. M. Exercise, physical conditioning, blood coagulation and fibrinolysis. Thromb Diath Haemorrh. 1974 Mar 15;31(1):63–71. [PubMed] [Google Scholar]
  20. Gonzales F., Mañas M., Seiquer I., Quiles J., Mataix F. J., Huertas J. R., Martinez-Victoria E. Blood platelet function in healthy individuals of different ages. Effects of exercise and exercise conditioning. J Sports Med Phys Fitness. 1996 Jun;36(2):112–116. [PubMed] [Google Scholar]
  21. Gough S. C., Whitworth S., Rice P. J., Grant P. J. The effect of exercise and heart rate on fibrinolytic activity. Blood Coagul Fibrinolysis. 1992 Apr;3(2):179–182. doi: 10.1097/00001721-199204000-00006. [DOI] [PubMed] [Google Scholar]
  22. Handa K., Terao Y., Mori T., Tanaka H., Kiyonaga A., Matsunaga A., Sasaki J., Shindo M., Arakawa K. Different coagulability and fibrinolytic activity during exercise depending on exercise intensities. Thromb Res. 1992 Jun 1;66(5):613–616. doi: 10.1016/0049-3848(92)90317-4. [DOI] [PubMed] [Google Scholar]
  23. Hansen J. B., Wilsgård L., Olsen J. O., Osterud B. Formation and persistence of procoagulant and fibrinolytic activities in circulation after strenuous physical exercise. Thromb Haemost. 1990 Nov 30;64(3):385–389. [PubMed] [Google Scholar]
  24. Hawkey C. M., Britton B. J., Wood W. G., Peele M., Irving M. H. Changes in blood catecholamine levels and blood coagulation and fibrinolytic activity in response to graded exercise in man. Br J Haematol. 1975 Mar;29(3):377–384. doi: 10.1111/j.1365-2141.1975.tb01835.x. [DOI] [PubMed] [Google Scholar]
  25. Hegde S. S., Goldfarb A. H., Hegde S. Clotting and fibrinolytic activity change during the 1 h after a submaximal run. Med Sci Sports Exerc. 2001 Jun;33(6):887–892. doi: 10.1097/00005768-200106000-00006. [DOI] [PubMed] [Google Scholar]
  26. Herren T., Bärtsch P., Haeberli A., Straub P. W. Increased thrombin-antithrombin III complexes after 1 h of physical exercise. J Appl Physiol (1985) 1992 Dec;73(6):2499–2504. doi: 10.1152/jappl.1992.73.6.2499. [DOI] [PubMed] [Google Scholar]
  27. Hyers T. M., Martin B. J., Pratt D. S., Dreisin R. B., Franks J. J. Enhanced thrombin and plasmin activity with exercise in man. J Appl Physiol Respir Environ Exerc Physiol. 1980 May;48(5):821–825. doi: 10.1152/jappl.1980.48.5.821. [DOI] [PubMed] [Google Scholar]
  28. IATRIDIS S. G., FERGUSON J. H. Effect of physical exercise on blood clotting and fibrinolysis. J Appl Physiol. 1963 Mar;18:337–344. doi: 10.1152/jappl.1963.18.2.337. [DOI] [PubMed] [Google Scholar]
  29. IKKALA E., MYLLYLAE G., SARAJAS H. S. HAEMOSTATIC CHANGES ASSOCIATED WITH EXERCISE. Nature. 1963 Aug 3;199:459–461. doi: 10.1038/199459a0. [DOI] [PubMed] [Google Scholar]
  30. Lin X., El-Sayed M. S., Waterhouse J., Reilly T. Activation and disturbance of blood haemostasis following strenuous physical exercise. Int J Sports Med. 1999 Apr;20(3):149–153. doi: 10.1055/s-2007-971109. [DOI] [PubMed] [Google Scholar]
  31. Mandalaki T., Dessypris A., Louizou C., Bossinakou I., Panayotopoulou C., Antonopoulou A. Marathon run I: effects on blood coagulation and fibrinolysis. Thromb Haemost. 1977 Jun 30;37(3):444–450. [PubMed] [Google Scholar]
  32. Mandalaki T., Dessypris A., Louizou C., Panayotopoulou C., Dimitriadou C. Marathon Run III: effects on coagulation, fibrinolysis, platelet aggregation and serum cortisol levels. A 3-year study. Thromb Haemost. 1980 Feb 29;43(1):49–52. [PubMed] [Google Scholar]
  33. Maron B. J., Poliac L. C., Roberts W. O. Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol. 1996 Aug;28(2):428–431. doi: 10.1016/0735-1097(96)00137-4. [DOI] [PubMed] [Google Scholar]
  34. Marsh N., Gaffney P. Some observations on the release of extrinsic and intrinsic plasminogen activators during exercise in man. Haemostasis. 1980;9(4):238–247. doi: 10.1159/000214362. [DOI] [PubMed] [Google Scholar]
  35. Martin D. G., Ferguson E. W., Wigutoff S., Gawne T., Schoomaker E. B. Blood viscosity responses to maximal exercise in endurance-trained and sedentary female subjects. J Appl Physiol (1985) 1985 Aug;59(2):348–353. doi: 10.1152/jappl.1985.59.2.348. [DOI] [PubMed] [Google Scholar]
  36. Molz A. B., Heyduck B., Lill H., Spanuth E., Röcker L. The effect of different exercise intensities on the fibrinolytic system. Eur J Appl Physiol Occup Physiol. 1993;67(4):298–304. doi: 10.1007/BF00357626. [DOI] [PubMed] [Google Scholar]
  37. Prisco D., Paniccia R., Bandinelli B., Fedi S., Cellai A. P., Liotta A. A., Gatteschi L., Giusti B., Colella A., Abbate R. Evaluation of clotting and fibrinolytic activation after protracted physical exercise. Thromb Res. 1998 Jan 15;89(2):73–78. doi: 10.1016/s0049-3848(97)00293-4. [DOI] [PubMed] [Google Scholar]
  38. Rankinen T., Väisänen S., Penttilä I., Rauramaa R. Acute dynamic exercise increases fibrinolytic activity. Thromb Haemost. 1995 Feb;73(2):281–286. [PubMed] [Google Scholar]
  39. Rock G., Tittley P., Pipe A. Coagulation factor changes following endurance exercise. Clin J Sport Med. 1997 Apr;7(2):94–99. doi: 10.1097/00042752-199704000-00004. [DOI] [PubMed] [Google Scholar]
  40. Röcker L., Drygas W. K., Heyduck B. Blood platelet activation and increase in thrombin activity following a marathon race. Eur J Appl Physiol Occup Physiol. 1986;55(4):374–380. doi: 10.1007/BF00422736. [DOI] [PubMed] [Google Scholar]
  41. Röcker L., Taenzer M., Drygas W. K., Lill H., Heyduck B., Altenkirch H. U. Effect of prolonged physical exercise on the fibrinolytic system. Eur J Appl Physiol Occup Physiol. 1990;60(6):478–481. doi: 10.1007/BF00705040. [DOI] [PubMed] [Google Scholar]
  42. Siegel A. J., Stec J. J., Lipinska I., Van Cott E. M., Lewandrowski K. B., Ridker P. M., Tofler G. H. Effect of marathon running on inflammatory and hemostatic markers. Am J Cardiol. 2001 Oct 15;88(8):918-20, A9. doi: 10.1016/s0002-9149(01)01909-9. [DOI] [PubMed] [Google Scholar]
  43. Szymanski L. M., Pate R. R. Effects of exercise intensity, duration, and time of day on fibrinolytic activity in physically active men. Med Sci Sports Exerc. 1994 Sep;26(9):1102–1108. [PubMed] [Google Scholar]
  44. Weiss C., Seitel G., Bärtsch P. Coagulation and fibrinolysis after moderate and very heavy exercise in healthy male subjects. Med Sci Sports Exerc. 1998 Feb;30(2):246–251. doi: 10.1097/00005768-199802000-00012. [DOI] [PubMed] [Google Scholar]
  45. Wheeler M. E., Davis G. L., Gillespie W. J., Bern M. M. Physiological changes in hemostasis associated with acute exercise. J Appl Physiol (1985) 1986 Mar;60(3):986–990. doi: 10.1152/jappl.1986.60.3.986. [DOI] [PubMed] [Google Scholar]
  46. Whitten C. W., Greilich P. E. Thromboelastography: past, present, and future. Anesthesiology. 2000 May;92(5):1223–1225. [PubMed] [Google Scholar]
  47. el-Sayed M. S. Effects of exercise on blood coagulation, fibrinolysis and platelet aggregation. Sports Med. 1996 Nov;22(5):282–298. doi: 10.2165/00007256-199622050-00002. [DOI] [PubMed] [Google Scholar]
  48. el-Sayed M. S. Exercise intensity-related responses of fibrinolytic activity and vasopressin in man. Med Sci Sports Exerc. 1990 Aug;22(4):494–500. [PubMed] [Google Scholar]
  49. el-Sayed M. S. Fibrinolytic and hemostatic parameter response after resistance exercise. Med Sci Sports Exerc. 1993 May;25(5):597–602. [PubMed] [Google Scholar]
  50. van den Burg P. J., Hospers J. E., van Vliet M., Mosterd W. L., Bouma B. N., Huisveld I. A. Changes in haemostatic factors and activation products after exercise in healthy subjects with different ages. Thromb Haemost. 1995 Dec;74(6):1457–1464. [PubMed] [Google Scholar]

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