Table 4.
Changes of thromboelastometry, thrombin generation and platelet function during exposure to high altitude (ten studies, n = 210).
| References | Altitude level [m] |
Participants
M/F, age [years] |
Type of
physical activity |
Maximum duration | Parameter | Maximum change | Level of significance† | |
|---|---|---|---|---|---|---|---|---|
| Active | Passive | |||||||
| High altitude | ||||||||
| Coppel et al. (18) | 4,500 (simulated) |
15 M, 13 F (only data from 25 subjects) 25 (median) |
Activities of daily living | 8 h | Thrombelastometry: Split time (sec) R time (sec) |
–19% –19% |
p = 0.022 p = 0.004 |
|
| Kicken et al. (20) | 3,883 (terrestrial) |
11 M, 7 F (only data from 17 subjects) 21–50 |
Ascent by car and cable car | 6 days | TG in WB: Peak height (nM) ETP (nM/min) TG in PRP: Peak height (nM) ETP (nM/min) Time to peak (min) |
+28% +26% +23% +34% +10% |
p = 0.0004 p = 0.0002 p = 0.0006 p < 0.0001 p = 0.03 |
|
| PLT activation (spontaneous): P-selectin (MFI) αIIbβ3 (MFI) PLT activation + ADP: P-selectin (MFI) αIIbβ3 (MFI) PLT activation + CRP: P-selectin (MFI) αIIbβ3 (MFI) PLT activation + TRAP: P-selectin (MFI) αIIbβ3 (MFI) |
–23% –20% –30% –21% –14% –17% –14% –5% |
p = 0.0031 p = 0.0032 p < 0.0001 p < 0.0001 p < 0.0001 p = 0.001 p < 0.0001 p < 0.0001 |
||||||
| Kicken et al. (21) | 3,375 (terrestrial) |
6 M 18–48 |
Vigorous exercise | 6 days | TG in PRP ETP (nM/min) TG in PPP after addition of high dose of TF: ETP (nM/min) |
–58% +11% |
p = 0.003 p = 0.03 |
|
| PLT activation + CRP: P-selectin (MFI)b αIIbβ3 (MFI)a P-selectin (MFI)b αIIbβ3 (MFI)b PLT activation + TRAP-6: P-selectin (MFI)a αIIbβ3 (MFI)a P-selectin (MFI)b αIIbβ3 (MFI)b |
–615# –1.305# –1.436# –1.610# –665# –423# –1.351# –498# |
NS p < 0.05 p < 0.05 p < 0.05 NS p < 0.05 p < 0.05 p < 0.05 |
||||||
| Lehmann et al. (22) | 4,559 (terrestrial) |
36 M, 4 F (only data from 10 controls) 40 ± 9 |
Climbing | 18 h | PLT function (PFA-100): Closure time + ADP (sec) Closure time + EPI (sec) PLT activation (spontaneous): P-selectin (ng/mL) |
–29% –31% +277% |
p ≤ 0.001 p ≤ 0.001 p < 0.001 |
|
| Martin et al. (24) | 5,300 (terrestrial) |
12 M, 5 F 34.0 ± 9.8 |
Climbing | 17 days | Thrombelastometry: R-time (sec) K-time (sec) α-angle (degree) |
+30% +207% –30% |
p = 0.016 p < 0.001 p < 0.001 |
|
| Modesti et at. (25) | 5,400 (terrestrial) |
25 M, 6 F 24–62 |
Climbing | 19 days | InTEM CT (12d) | +10 | p = 0.003 | |
| InTEM CFT (12d) | +20% | p = 0.014 | ||||||
| InTEM alpha (12d) | –5% | p = 0.012 | ||||||
| InTEM MAXV (12 +20d) | –18% | p < 0.001 | ||||||
| Ninivaggi et al. (26) | 3,900 (terrestial) |
16 M, 14 F 28–32 |
G1: 7 M, 8 F Climbing |
G2: 7 M, 8 F Ascent by cable car |
8 days | TG in WB: G 1 (active): Peak height (nM) ETP (nM/min) Lag time (sec) Time to peak (sec) Velocity index |
+23% +18% –30% –45% +50% |
p < 0.05 p < 0.05 p < 0.05 p < 0.05 p < 0.05 |
| G2 (passive): Peak height (nM) ETP (nM/min) Lag time (sec) Time to peak (sec) Velocity index |
+50% +38% –33% –29% +50% |
p < 0.05 p < 0.05 p < 0.05 p < 0.05 p < 0.05 |
||||||
| Rocke et al. (28) | 5,200 (terrestrial) |
12 M, 10 F (only data from Apex 4 available) 26.4 ± 3.9 |
Ascent by plane and car | 7 days | Thrombelastometry: FibTEM A20 (mm) ExTEM A20 (mm) |
+22% +6% |
p < 0.01 p < 0.01 |
|
| PLT function (Multiplate): ADP AUC (AU) |
+22% |
p < 0.01 |
||||||
| PLT function (PFA-100): Closure time + EPI |
–50% |
p < 0.00001 |
||||||
| Schaber et al. (29) | 4,500 (simulated) |
21 M, 16 F (only data from 14 subjects) 19–42 |
Free movement | 12 h | Thrombelastometry InTEM CT (sec) InTEM MCF (mm) FibTEM MCF (mm) |
–4% +4% +12% |
p = 0.012 p = 0.039 p = 0.035 |
|
| Sharma (30) | 3,000 (terrestrial) |
15 M 21–26 |
Activities of daily living | 21–30 days | Platelet adhesiveness (%) | +14% | p < 0.001 | |
F, female; M, male; ADP, adenosine diphosphate; AU, aggregation units; AUC, area under the curve; αIIbβ3, fibrinogen αIIbβ3 receptor; Cmax, maximum concentration of thrombin; CRP, collagen-related peptide; CFT, clot formation time; CT, clotting time; EPI, epinephrine; ETP, endogenous thrombin potential; G group; GXT, graded exercise test; HAPE, high altitude pulmonary edema; MAXV, maximum velocity; MFI median fluorescence intensity expressed in arbitrary units; min, minute; mm, millimeter; nM, nanomol; PFA, platelet function analysis; PLT, platelet; PPP, platelet-poor-plasma; PRP, platelet-rich plasma; R-time, reaction time; ROTEM, rotational thromboelastometry; sec, second; SP, split point; TF, tissue factor; TG, dynamic thrombin generation; tPA, tissue plasminogen activator; TRAP-6, thrombin receptor-activating peptide; WB, whole blood. All p-values reflect intragroup comparisons unless otherwise indicated. NS, not significant.
Results on 6th day 2 h before exercise.
Results on 6th day 2 h after exercise.
Changes expressed as absolute values.
Reported in the original study.