Does breath-holding increase the risk of a thrombotic event?

Baković, Darija; Eterović, Davor; Palada, Ivan; Valić, Zoran; Dujić, Željko

doi:10.1080/09537100801910846

Cited by 5 publications

(12 citation statements)

References 12 publications

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“…These results agree with the inverse relationship between platelet count and MPV reported in cardiac patients (Huczek et al, 2005;Yang et al, 2006), in correlation with severity of a disease (Pizzulli et al, 1998). To assess the reproducibility of measuring MPV and spleen volume, we have combined our own data from two different studies that used the same subjects and were performed within 2 weeks (Bakovic et al, 2008(Bakovic et al, , 2009. The large platelets are recognized as a strong independent predictor of impaired angiographic reperfusion and 6-month mortality in patients presenting with ST elevation myocardial infarction (Huczek et al, 2005;Yang et al, 2006).…”

Section: Baselinesupporting

confidence: 79%

The effects of low‐dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets

Baković

Pivac

Eterović

et al. 2012

Clin Physio Funct Imaging

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In several conditions associated with adrenergic stimulation, an increase in peripheral count of larger platelets has been observed, but the mechanism remained elusive. Larger platelets have greater prothrombotic potential and increase the risk of acute thrombotic events. The human spleen retains one-third of total body platelets, with mean volume (MPV) about 20% greater than that of circulating platelets. We aimed to answer whether low-dose epinephrine infusion results in spleen contraction and MPV increase. We undertook the continuous ultrasonic measurements of spleen volume, hepatic and central circulation with concurrent blood sampling in response to intravenous infusion of epinephrine (6 min of 0·06 µg kg(-1) per min, followed by 3 min of 0·12 µg kg(-1) per min) in nine healthy young subjects. The spleen volume started to decrease immediately after the onset of infusion, in the presence of substantial decreases in peripheral resistance and mean blood pressure and increases in heart rate and cardiac output. The majority of spleen emptying, approximately 25%, (95% CI 71·3-299·7) was observed 1 min after infusion onset, the hepatic vein flow peaked at the end of infusion for 28·4% (95% CI 1074·6-407·9), while increases in platelet count for approximately 31% (95% CI 187·8-314·8) and MPV for 4·4% (95% CI 7·3-10·9) lagged until 1 min after infusion cessation. We suggest that spleen is a dynamic reservoir of large platelets, which are mobilized even by low-dose epinephrine infusion in conditions of decreased blood pressure.

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Section: Baselinesupporting

confidence: 79%

The effects of low‐dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets

Baković

Pivac

Eterović

et al. 2012

Clin Physio Funct Imaging

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“…The spleen contains not only a reserve of red cells, but around 40% of the body's reserve of leucocytes (Bierman, Byron, & Kelly, 1953), and as many as a third of the body's platelets (Baković, Eterovic, Palada, Valic, & Dujic, 2008). In stressful situations, these elements can be liberated into the general circulation as a part of the "fight or flight" reaction.…”

Section: Immunological Significance Of the Spleenmentioning

confidence: 98%

“…The spleen contains a high proportion of large platelets, and their expulsion into the general circulation could predispose to thrombotic incidents (Baković et al, 2008(Baković et al, , 2009). …”

Section: Immunological Significance Of the Spleenmentioning

confidence: 99%

Responses of the human spleen to exercise

Shephard

2015

Journal of Sports Sciences

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The human spleen shows a decrease in volume of around 40% early during vigorous exercise and in response to other stressful stimuli such as maximal apnoea and the breathing of hypoxic gas mixtures. Contraction seems an active response, mediated by alpha-adrenergic fibres in the splenic nerve. Given the relatively small size of the human spleen, the effect upon physical performance is likely to be small; the augmentation of total blood volume is <2%, and even taking account of other causes of haemoconcentration during vigorous exercise, the increase of haematocrit is <10%. However, one of two studies suggested that the haemoconcentration may be sufficient to cause errors in the traditional method for calculating exercise-induced changes of plasma volume. The spleen also contributes leucocytes and platelets to the general circulation as part of the "fight or flight" reaction to stressors. The mobilisation of leucocytes proceeds more slowly than that of the red cells; it depends not only upon an active contraction of the spleen, but also a modulation of leucocyte adhesion molecules. Splenectomy impairs exercise performance in horses, but human performance data are lacking; overall health effects seem minimal, and many patients live many years after removal of their spleens.

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“…A few recent studies have shown a strong connection between high MPV and thrombotic events like acute coronary incidents and stroke [72][73][74]. If we knew whether these conditions were associated with a high level of sympathetic activation, then we could reach the conclusion that the centrally-mediated splenic contraction is an important source of large platelets, thereby increasing the risk of sudden coronary incidents [71]. In our recent study [75], we found an increase in MPV in response to splenic contraction induced by low dose epinephrine infusion in conditions of decreased blood pressure.…”

Section: Fainting During Breath-holdmentioning

confidence: 94%

“…To further elucidate this problem, Bakovic et al [71] provided the results of changes in both MPV and total platelets in response to repetitive breath-hold dives in three groups of subjects: trained apnea divers, untrained intact, and splenectomized subjects. A few recent studies have shown a strong connection between high MPV and thrombotic events like acute coronary incidents and stroke [72][73][74].…”

Section: Fainting During Breath-holdmentioning

confidence: 99%

Breath-hold diving as a brain survival response

Dujić

Brešković

Baković

2013

Translational Neuroscience

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Apnea disciplines and current records BREATH HOLD DIVING AS A BRAIN SURVIVAL RESPONSE AbstractElite breath-hold divers are unique athletes challenged with compression induced by hydrostatic pressure and extreme hypoxia/hypercapnia during maximal field dives. The current world records for men are 214 meters for depth (Herbert Nitsch, No-Limits Apnea discipline), 11:35 minutes for duration (Stephane Mifsud, Static Apnea discipline), and 281 meters for distance (Goran Čolak, Dynamic Apnea with Fins discipline). The major physiological adaptations that allow breath-hold divers to achieve such depths and duration are called the "diving response" that is comprised of peripheral vasoconstriction and increased blood pressure, bradycardia, decreased cardiac output, increased cerebral and myocardial blood flow, splenic contraction, and preserved O 2 delivery to the brain and heart. This complex of physiological adaptations is not unique to humans, but can be found in all diving mammals. Despite these profound physiological adaptations, divers may frequently show hypoxic loss of consciousness. The breath-hold starts with an easy-going phase in which respiratory muscles are inactive, whereas during the second so-called "struggle" phase, involuntary breathing movements start. These contractions increase cerebral blood flow by facilitating left stroke volume, cardiac output, and arterial pressure. The analysis of the compensatory mechanisms involved in maximal breath-holds can improve brain survival during conditions involving profound brain hypoperfusion and deoxygenation.

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Does breath-holding increase the risk of a thrombotic event?

Cited by 5 publications

References 12 publications

The effects of low‐dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets

The effects of low‐dose epinephrine infusion on spleen size, central and hepatic circulation and circulating platelets

Responses of the human spleen to exercise

Breath-hold diving as a brain survival response

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