Effect of Air Travel on Exercise-Induced Coagulatory and Fibrinolytic Activation in Marathon Runners

Abstract

Results suggest that the combination of air travel and marathon running induces an acute hypercoaguable state; this hemostatic imbalance is exaggerated with increasing age.

An update on the Boston Marathon as a research laboratory

“…Case reports of deep vein thrombosis (DVT) and pulmonary embolism (PE) in endurance athletes after the combination of prolonged travel to and from endurance events, however, suggest that the combination of travel and endurance exercise increases thrombotic risk [24]. We examined this hypothesis in 41 runners in the 2010 BAA [21,25], who either flew >4 hour or drove <2 hours to the race. Blood samples for TAT, t-PA, d-dimer (a derivative of crosslinked fibrin, which is elevated during thrombolysis), p-selectin (an adhesion glycoprotein that initiates the inflammatory cascade and regulates thrombus size), and microparticles (small fragments of cell membrane phospholipids that circulate and amplify coagulation) levels were obtained the day before, immediately after the marathon, and the day after the marathon following the flight home.…”

Marathon Maladies: Venous Thromboembolism Risk Associated with Marathon Running

“…We were the first group to examine the effect of prolonged exercise and air travel on thrombotic risk factors (3,18). We examined 41 time-qualified runners participating in the 2010 Boston Marathon who either flew >4 h (travel) or drove <2 h (control) to the race.…”

“…Our group recently examined the safety and efficacy of compression socks worn during a marathon on hemostatic activation immediately following the 2013 Hartford Marathon (34). Using a similar study design as previously described (18), venous blood samples were obtained before, immediately after, and the day after a marathon for the assessment of coagulatory factors (ie, TAT and d-dimer), a fibrinolytic factor (ie, t-PA activity), and hematocrit. Subjects in the sock group (n = 10) were compression sock naïve and received their socks (2XU Compression Performance Run Sock; 19-25 mmHg at the ankle) at the marathon expo and were instructed to wear them to the race start and throughout the duration of the marathon.…”

“…Strenuous endurance exercise (e.g., marathon running) activates the coagulatory system by immediately increasing markers of coagulation such as thrombin-antithrombin complex (TAT), prothrombin fragment 1 and 2, and d-dimer (5,18,22). However, the fibrinolytic system (e.g., tissue plasminogen activator [t-PA] antigen and activity) is activated in coordination with the coagulatory system, such that changes in coagulation are paralleled by an activation of fibrinolysis to preserve hemostatic balance.…”

Seasonal and individual characteristics of the response of the fibrinolytic system of blood to physical exercise

“…A single muscular load usually enhances the activator component of the fibrinolytic system to varying degrees, which manifests itself, in particular, as an increase in the blood level of the tissue activator plasminogen and a decrease in the activity of the plas minogen activator inhibitor type 1 [7][8][9][10][11]. However, the overall blood fibrinolytic activity after a single or repeated exercise may change in different ways (increase, remain unchanged, or decrease) depending on the initial state, level of working capacity, fatigue, sex, age, body weight, and many other factors [12][13][14][15].…”