REVIEWShort- and Long-term exercise induced alterations in haemostasis: a review of the literature
Introduction
Regular exercise is beneficial for health and reduces the risk of cardiovascular diseases. However, since the early 1900s, many cases of exercise-induced thrombotic events, including myocardial infarction, ischemic stroke and venous thromboembolism, have been reported. This apparent paradox is reflected by conflicting data derived from various cohorts, describing both increased and decreased risks of thrombotic events upon exercise, possibly due to many confounding factors such as: age, gender, training status, intensity and duration of the exercise. In spite of the absence of incidence data on exercise-induced thrombotic events compared with the general population, the overall impression is that high intensity exercise results in an elevated risk of thrombotic events, as compared to mild-intensity exercise. This suggests that different types of exercise may have different effects on the haemostatic profile and might be important determinants of exercise-induced thrombotic events. Exercise has long been recognized as a potential activator and modulator of coagulation and platelet activity. Already in 1968, Cohen et al. reported alterations in coagulation as well as in fibrinolysis, the process of fibrin degradation, in relation to exercise [1]. In this review we provide an update of the literature on haemostatic changes secondary to exercise, especially for the different durations and intensities. Moreover, we will discuss the possible underlying mechanisms of the affected processes during exercise. We divided activity in short-term (< 1 h) and long-term exercise (> 1 h). Also, 3 types of exercise intensity were recognized: moderate (50–60%), submaximal (70–80%) and maximal (100%) intensity, based on the maximum heart rate (220-age) or on individual anaerobic threshold (maximum heart rate minus 15 or lactate values). If the intensity was not given, we set this arbitrarily at 70–80% for marathon studies, since maximal intensity can only be reached in short-term exercise like treadmill or maximal ergo test.
Section snippets
Platelet count
Platelet counts after exercise have been thoroughly investigated and most studies reported increased platelet counts during all type of intensity and/or duration [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32]. Herren et al. found increased numbers of platelets depending on exercise intensity [4], an observation later confirmed by others [12], [32], [33] (Table 1).
Conclusion
Although it is established that regular exercise is beneficial for health, many exercise-induced thrombotic events have been reported in the past. This indicates that exercise is a trigger for clot formation, but the mechanism behind this is still unknown. Studies showed that high intensity, but not low intensity exercise tends to increase the risk on exercise-induced thrombotic events, which indicates that different types of exercise have various effects on the haemostatic profile. We showed
Practice points
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Exercise increases coagulation activity in an intensity dependent manner.
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The exercise-associated hypercoagulability may influence the risk of thrombotic events, especially in persons with predisposing cardiovascular risk factors.
Research agenda
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Establishing better estimates of the incidence of exercise-induced thrombotic events.
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Identifying the trigger(s) for activation of haemostatic processes during exercise.
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Assessing the effects of exercise on plasminogen levels as a determinant of fibrinolytic activity.
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Assessing risk factors for the development of an exercise-induced thrombotic event.
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Establishing the possible value of primary antithrombotic prevention in subjects at increased risk for acute cardiovascular thrombotic events who
Conflicts of interest
None declared.
Acknowledgements
None.
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