Changes in blood coagulation and fibrinolysis associated with maximal exercise and physical conditioning in women taking low dose oral contraceptives

Effect of regular exercise training on platelet function in patients with cardiovascular disease and healthy individuals: A systematic review

INTRODUCTION

Regular exercise training is essential in prevention and treatment of cardiovascular disease (CVD), yet the beneficial effects of exercise remain only partly explained. Platelets play a key role in CVD and may be affected by regular exercise training. We aimed to systematically summarise studies investigating the effect of regular exercise training on platelet function in patients with CVD and in healthy individuals.

METHODS

Studies were identified by PubMed, Embase and Web of Science May 16, 2022. We selected studies investigating markers of platelet function in relation to regular exercise training in patients with CVD and in healthy individuals. Regular exercise was defined as exercise training for four weeks or more.

RESULTS

Of the included studies, 11 investigated patients with CVD and 29 were on healthy individuals. Studies were heterogeneous regarding design, study population and methodology, and the results were ambiguous. In total, 52 different markers of platelet function were investigated with platelet aggregation, soluble P-selectin, and thromboxane B2 (TXB2) as the most frequently examined. When evaluating between-group changes after regular exercise, two studies found a reduced platelet aggregation in the exercise group whilst three studies did not find a difference between groups. With respect to TXB2, three studies reported a reduction and two studies an increase in the exercise group. There were no between-group differences in the seven studies examining soluble P-selectin.

CONCLUSION

Regular exercise training has no clear impact on platelet function in patients with CVD or healthy individuals.

PROSPERO REGISTRATION

CRD42022350539.

Regular Resistance Training Enhances Fibrinolytic Potential but Does Not Affect Coagulation

PURPOSE

This study aimed to identify effects of an 8-wk, whole-body RT program on coagulation and fibrinolysis.

METHODS

Sixteen healthy women and men (23 ± 5 yr) completed an RT program three times per week for 8 wk. Exercises included 2-3 sets of 8-12 repetitions performed at approximately 60%-80% of a one repetition maximum. Strength, body composition, and body circumferences were assessed before and after training. Plasma samples were obtained before and after training, and analyzed for active tissue plasminogen activator (tPA activity), total tissue plasminogen activator (tPA antigen), active plasminogen activator inhibitor-1 (PAI-1 activity), total plasminogen activator inhibitor-1 (PAI-1 antigen), fibrinogen, and coagulation factors VII (FVII) and VIII (FVIII).

RESULTS

Significant increases in lean mass, arm and thigh circumferences, maximal chest press (PRE: 57.8 ± 37.5 kg, POST: 73.3 ± 43.2 kg), and leg press (PRE: 189.5 ± 96.0 kg, POST: 256.7 ± 97.9 kg) were observed (P < 0.05 for all). PAI-1 activity (PRE: 20.3 ± 32.5 IU·mL-1, POST 9.5 ± 20.9 IU·mL-1) and PAI-1 antigen decreased (PRE: 10.2 ± 9.0 ng·dL-1, POST: 7.2 ± 5.7 ng·dL-1; both, P < 0.05). No change in tPA activity or tPA antigen occurred. Fibrinogen, FVII, and FVIII did not change after training.

CONCLUSIONS

Inhibition of fibrinolysis was decreased after training, and coagulation was unaffected. These results suggest that regular RT may beneficially influence the risk of a thrombotic event. More research is warranted to understand the mechanisms through which RT affects hemostasis.

PAI-1, the Plasminogen System, and Skeletal Muscle

The plasminogen system is a critical proteolytic system responsible for the remodeling of the extracellular matrix (ECM). The master regulator of the plasminogen system, plasminogen activator inhibitor-1 (PAI-1), has been implicated for its role in exacerbating various disease states not only through the accumulation of ECM (i.e., fibrosis) but also its role in altering cell fate/behaviour. Examination of PAI-1 has extended through various tissues and cell-types with recent investigations showing its presence in skeletal muscle. In skeletal muscle, the role of this protein has been implicated throughout the regeneration process, and in skeletal muscle pathologies (muscular dystrophy, diabetes, and aging-driven pathology). Needless to say, the complete function of this protein in skeletal muscle has yet to be fully elucidated. Given the importance of skeletal muscle in maintaining overall health and quality of life, it is critical to understand the alterations—particularly in PAI-1—that occur to negatively impact this organ. Thus, we provide a comprehensive review of the importance of PAI-1 in skeletal muscle health and function. We aim to shed light on the relevance of this protein in skeletal muscle and propose potential therapeutic approaches to aid in the maintenance of skeletal muscle health.

Hemostatic Adaptations to High Intensity Interval Training in Healthy Adult Men

Regular exercise is theorized to reduce cardiovascular risk by attenuating coagulation and augmenting fibrinolysis. However, these adaptations have not been consistently observed during traditional exercise programs. The purpose of this study was to examine hemostatic adaptations in healthy men following four (4W) and eight (8W) weeks of high intensity interval training. Twenty-one men (age=25±1 y; body mass index=26.5±6.4 kg/m²) completed eight weeks, three days/week of high intensity interval training on a cycle ergometer. Activated partial thromboplastin time, prothrombin time, and plasma concentrations of thrombin-antithrombin III, fibrinogen, tissue plasminogen activator, and plasminogen activator inhibitor-1 were assessed at baseline (BL), 4W, and 8W. Repeated measures ANOVA were used to determine potential effects of training. There were no significant changes observed for activated partial thromboplastin time (BL=43.3±5.5, 4W=43.2±5.1, 8W=44.2±6.4 s); prothrombin time (BL=13.2±0.9, 4W=13.0±0.6, 8W=13.1±0.8 s); thrombin-antithrombin III (BL=6.0±2.3, 4W=5.8±2.3, 8W=5.6±3.1 ng/mL); tissue plasminogen activator (BL=9.7±3.3, 4W=9.4±3.2, 8W=8.7±2.8 ng/mL); and plasminogen activator inhibitor-1 (BL=19.0±17.5, 4W=19.3±17.0, 8W=18.9±18.9 ng/mL) (all p>0.05). Fibrinogen was significantly lower at 4W (238.6±70.3 mg/dL) compared to BL (285.0±82.1 mg/dL; p<0.05) and 8W (285.3±83.2 mg/dL; p<0.05). These findings indicate that eight weeks of high intensity interval training does not influence coagulation potential and/or stimulate fibrinolysis.

Venous thromboemboli associated with acute aerobic exercise: A review of case report commonalities

Venous thromboembolic (VTE) events such as deep vein thrombosis (DVT) and pulmonary embolism (PE) have been reported in otherwise low-risk healthy athletes following acute bouts of aerobic exercise.

PURPOSE

To review case reports and assess the commonalities of athletic individuals with VTE, as well as return-to-play (RTP) recommendations.

METHODS

We reviewed 47 reports (20 DVTs, 15 PEs, and 12 DVTs/PEs, 19 women) of trained individuals who were diagnosed with DVT and/or PE following aerobic exercise. We assessed frequency of VTE risk factors, presenting symptoms, and RTP recommendations.

RESULTS

The age of women (24.6 ± 7.0 years) was lower (P < .01) than of men (40.6 ± 13.6 years). Of the 19 women, 14 (73.7%) used oral contraceptives. Thirteen cases (27.7%) reported a recent period of prolonged inactivity (>1 hour), and another 12 cases were found to have an antithrombin disorder following testing after diagnosis. The most frequently reported symptoms were muscle pain in 26 of 32 (81.3%) DVT or DVT/PE cases, and dyspnea in 21 of 27 (77.8%) PE or DVT/PE cases. Despite these common symptoms, the estimated time from first report of symptoms to confirmed diagnosis was 56.3 ± 118.7 days and 25 cases (53.2%) were initially misdiagnosed. Twenty-three cases (48.9%) did not report RTP recommendations, and those which did varied widely.

CONCLUSIONS

Thirty-two cases (~70%) had at least one of three major risk factors, suggesting that many cases of VTE in athletes may be preventable with better education and awareness. The wide variety of RTP recommendations highlights the need for standardized guidelines in this population.

Compression Socks Worn During Flight and Hemostatic Balance in Boston Marathon Runners on Oral Contraceptives

OBJECTIVE

To investigate the effect of oral contraceptive (OC) use and compression socks on hemostatic activation in women flying cross-country to and from a marathon.

DESIGN

Prospective study.

SETTING

2015 Boston Marathon.

PARTICIPANTS

Women were divided into non-OC using (CONTROL; n = 12), OC-using (OC; n = 15), and OC-using plus compression sock (OC + SOCK; n = 14) groups.

INTERVENTION

Women in OC + SOCK wore compression socks during flights to and from the marathon.

MAIN OUTCOME MEASURES

Venous blood samples were collected within 24 hours of arriving in Boston (EXPO), immediately after the marathon (RUN), and within 24 hours after a return flight home (Post-Flight) for analysis of thrombin-antithrombin complex (TAT), d-dimer, and tissue plasminogen activator (t-PA).

RESULTS

TAT did not increase with exercise (P = 0.48) and was not affected by group (P = 0.08) or the interaction between these 2 factors (P = 0.80). Group, time, and their interaction were significant for d-dimer (all P < 0.05) such that d-dimer increased with acute exercise to a greater extent (Δ d-dimer from expo to postrace = 909.5 ± 1021.9 ng/mL) in the OC + SOCK group relative to OC (Δ d-dimer = 240.0 ± 178.5 ng/mL; P = 0.02) and CONTROL (Δ d-dimer = 230.3 ± 120.3 ng/mL; P = 0.02). There was a significant effect of time, group, and the interaction on t-PA (all P < 0.01) such that t-PA increased with acute exercise to a greater extent (Δ t-PA from expo to postrace = 19.6 ± 10.0 ng/mL) in the CONTROL group relative to OC (Δ t-PA = 4.0 ± 1.8 ng/mL; P < 0.01) and OC + SOCK (Δ t-PA = 3.3 ± 1.2 ng/mL; P < 0.01).

CONCLUSIONS

Female runners using OCs did not exhibit disproportionately increased coagulation. The use of compression socks in women on OCs, surprisingly, resulted in a greater increase in d-dimer after exercise.

Treadmill exercise alleviates diabetic cardiomyopathy by suppressing plasminogen activator inhibitor expression and enhancing eNOS in streptozotocin-induced male diabetic rats

OBJECTIVE

To investigate the biological mechanism of the effect of different intensity exercises on diabetic cardiomyopathy.

METHODS

87 raise specific pathogen SPF healthy 6-week-old male Sprague-Dawley rats, fed 6 weeks with high-fat diet for rats were used, and a diabetic model was established by intraperitoneal injection of streptozotocin - randomly selected 43 rats were divided into Diabetic control group (DCG, n = 10), Diabetic exercise group 1 (DEG1, n = 11), Diabetic exercise group 2 (DEG2, n = 11) and Diabetic exercise group 3 (DEG3, n = 11). The rats in DEG1 were forced to run on a motorized treadmill, the exercise load consisted of running at a speed of 10 m/min, the exercise load of the rats in DEG2 were running at a speed of 15 m/min, the exercise load of the rats in DEG3 were running at a speed of 20 m/min, for one hour once a day for 6 weeks. After 6 weeks of exercise intervention, glucose metabolism-related indexes in rats such as blood glucose (FBG), glycosylated serum protein (GSP) and insulin (FINS); cardiac fibrinolytic system parameters such as PAI-1 (plasminogen activator inhibitor 1), Von Willebrand factor (vWF), protein kinase C (PKC) and diacylglycerol (DAG); and serum level of NO, eNOS and T-NOS were measured.

RESULT

Compared with DCG, fasting blood glucose and GSP were decreased, while insulin sensitivity index and insulin level were increased in all rats of the three exercise groups. FBG decrease was statistically significant (P < 0.01), only GSP decrease was statistically significant (P < 0.05) in DEG1 and DEG2, PAI-1 in three exercise groups were significantly reduced (P < 0.05), plasma vWF levels in the three exercise groups were significantly lower than those in the DCG group (P < 0.01); PKC levels decreased dramatically in the three exercise groups and DAG levels decrease slightly (P < 0.05), but with no significant difference. Compared with DCG, the serum level of NO was significantly higher (P < 0.05), and eNOS level was significantly elevated (P < 0.05). T-NOS elevation was statistically significant in DEG1 (P < 0.05).

CONCLUSIONS

Low- and moderate-intensity exercise can better control blood glucose level in diabetic rats; myocardial PAI-1 in DEG1, DEG2 and DEG3 rats decreased significantly (P < 0.05), serum NO increased (P < 0.05) and eNOS increased (P < 0.05) significantly. Therefore, it is inferred that exercise improves the biological mechanism of diabetic cardiomyopathy by affecting the levels of PAI-1 and eNOS, and there is a dependence on intensity.

Acute physical exercise is safe in patients with primary antiphospholipid syndrome with exclusive venous thrombosis and under oral anticoagulation with warfarin

The purpose of present study was to evaluate the effects of maximal acute physical exercise on prothrombin time/international normalized ratio (PT/INR) in patients with primary antiphospholipid syndrome (PAPS) under oral anticoagulation with warfarin and the safety of acute exercise in regard to thrombosis and bleeding risk. Eighteen physically inactive women with PAPS (Sydney criteria) with exclusive venous events and without thrombocytopenia were included. All patients were under stable warfarin therapy (PT/INR target: 2.0-3.0). Eighteen age-matched healthy sedentary women without thrombosis/bleeding disorders were selected as controls. All subjects performed a maximal exercise test, and capillary blood samples were obtained pre-, post- and at 1-h post-exercise (recovery time) for PT/INR analysis using a portable CoaguCheck. PAPS patients and controls had similar mean age (31.50 ± 8.06 vs. 29.61 ± 7.05 years, p = 0.46) and body mass index (24.16 ± 3.67 vs. 24.66 ± 2.71 kg/m(2), p = 0.65). PAPS had a mild but significant increase in PT/INR value at 1-h post-exercise (recovery) compared with pre- (2.33 ± 0.34 vs. 2.26 ± 0.29, p = 0.001) and post-exercise (2.33 ± 0.34 vs. 2.26 ± 0.32, p = 0.001) that was observed in 61.11 % of these patients. None of the subjects had thrombotic or bleeding complications related to the acute exercise. Acute exercise in patients with PAPS with exclusive venous thrombosis was safe with a minor increase in PT/INR. This is an important step to introduce regular exercise training as a therapeutic tool in the management of these patients.

Coagulation and fibrinolysis are in balance after moderate exercise in middle-aged participants

Increased age is associated with a higher risk of thrombotic events. The aim of this study was to investigate the age-related changes in hemostasis before and after moderate exercise controlled by individual anaerobic threshold as recommended for rehabilitation training. In this study, 24 young (25 +/- 1 years) and 24 middle-aged healthy nonsmokers (48 +/- 1 years) underwent an individualized exercise test with 80% of individual anaerobic threshold (young individuals: 127 +/- 6 W; middle-aged individuals: 128 +/- 5 W; values are expressed as mean +/- standard error of mean) for 60 minutes. The blood samples were collected before and after the exercise. The age-related higher (P < or = .05) levels could be detected in factors II, VII, VIII, IX, XI, XII, prothrombin fragment 1+2, in tissue plasminogen activator antigen and activity, as well as in plasminogen. The relative exercise-induced increases in these parameters were similar in both groups, although beginning at a higher level for those in the middle-aged group.A statistically enhanced increase after exercise in the middle-aged group could be shown in prothrombin fragment 1+2 (young individuals: 98 +/- 6 to 102 +/- 6 pmol/L; middle-aged individuals: 138 +/- 7 to 156 +/- 8 pmol/L) and in thrombin-antithrombin complex (young individuals: 2.2 +/- 0.1 to 3.1 +/- 0.2 microg/L; middle-aged individuals: 2.4 +/- 0.3 to 3.9 +/- 0.6 microg/L); the latter only showing a tendency. The data show the age-related changes with a rise in blood coagulation and fibrinolysis in a healthy middle-aged group compared with younger participants. Moderate exercise leads to comparably relative increases in hemostatic parameters but starting at higher levels. However, the exercise-induced thrombin generation (prothrombin fragment 1+2) is enhanced in the middle-aged participants in comparison with younger participants, but may be compensated by a sufficient fibrinolysis, and therefore the hemostatic system remains in balance.

Combined homology modelling and evolutionary significance evaluation of missense mutations in blood clotting factor VIII to highlight aspects of structure and function

Most small lesions in the factor VIII (FVIII) gene that cause haemophilia A (HA) are single nucleotide substitutions resulting in amino acid replacing (missense) mutations and leading to various phenotypes, ranging from mild to severe. We took a combined approach of homology modelling and quantitative evaluation of evolutionary significance of amino acid replacing alterations using the Grantham Matrix Score (GMS) to assess their structural effects and significance of pathological expression. Comparative homology models of all amino acid substitutions summarized in the FVIII mutations database plus these identified and reported lately by us or by our collaborators were evaluated. Altogether 640 amino acid replacing mutations were scored for potential distant or local conformation changes, influence on the molecular stability and predicted contact residues, using available FVIII domain models. The average propensity to substitute amino acid residues by mutation was found comparable to the overall probability of de novo mutations. Missense changes reported with various HA phenotypes were all confirmed significant using GMS. The fraction of these, comprising residues apparently involved in intermolecular interactions, exceeds the average proportion of such residues for FVIII. Predicted contact residues changed through mutation were visualized on the surface of FVIII domains and their possible functional implications were verified from the literature and are discussed considering available structural information. Our predictive modelling adds on the current view of domain interface molecular contacts. This structural insight could aid in part to the design of engineered FVIII constructs for therapy, to possibly enhance their stability and prolong circulating lifetime.

Regular sports activities decrease the risk of venous thrombosis

BACKGROUND

Stasis of the blood has been postulated as a major cause of venous thrombosis. However, little is known about the effect of stimulating the blood flow in order to prevent venous thrombosis through, for example, sports activities.

OBJECTIVES

In a large population-based case-control study (MEGA study), we studied whether participating in sports activities on a regular basis was associated with venous thrombosis risk.

PATIENTS/METHODS

Consecutive patients with a first venous thrombosis of the leg or a pulmonary embolism, and control subjects, consisting of partners of the patients and randomly selected control subjects from the general population, were asked to participate. Sports activities and other risk factors for venous thrombosis were reported in a standardized mailed questionnaire. Participants with malignancy were excluded.

RESULTS

Out of 3608 patients, 1136 (31.5%), and of our 4252 control subjects 1686 (39.7%), participated in sports activities. Participating in sports activities reduced the risk of venous thrombosis compared with not participating in sports activities [odds ratio (OR) 0.64; 95% CI 0.58-0.71]. Risk reductions were similar after adjustment for sex, age and body mass index (OR(adj) 0.71; 95% CI 0.64-0.78) and when the analysis was restricted to healthy individuals (OR(adj) 0.67; 95% CI 0.58-0.78). No differences in risk were found for various frequencies, intensities and types of sport.

CONCLUSION

Regular sports activities reduce the risk of venous thrombosis.

Haemophilia A: molecular insights

Haemophilia A is the most common inherited bleeding disorder caused by defects in the

Clin Chem Lab Med 2007;45:450–61.

Temporal Changes in tPA and PAI-1 after Maximal Exercise

PURPOSE

Although fibrinolysis increases with acute exercise, it decreases rapidly during the postexercise period. Therefore, the time point at which blood samples are collected postexercise could affect reported tissue plasminogen activator (t-PA) and/or plasminogen activator inhibitor-1 (PAI-1) levels. The purpose of this study was to determine the time course of t-PA and PAI-1 changes after acute maximal exercise.

METHODS

Eight healthy males performed a graded maximal exercise test on a treadmill. Venous blood samples were collected using an indwelling catheter before exercise and at 1, 2, 4, 6, 8, and 10 min postexercise. Mean differences in t-PA activity, t-PA antigen, and PAI-1 activity at each time point were assessed using a repeated measures ANOVA. Post hoc means comparisons were performed by contrasting the 1-min postexercise value against all other time points.

RESULTS

Both t-PA activity and t-PA antigen significantly increased from pre- to postexercise (P < 0.05). t-PA activity did not change from 1 to 2 min postexercise but decreased significantly at 4 min postexercise. Likewise, t-PA antigen remained elevated from 1 to 2 min postexercise but decreased at 4 min postexercise. PAI-1 decreased from pre- to postexercise but did not change during the 10-min postexercise period.

CONCLUSION

To accurately evaluate the t-PA response to acute exercise, blood samples should be collected within 2 min after the cessation of exercise.

Exercise-induced changes in coagulation and fibrinolysis in healthy populations and patients with cardiovascular disease

This review highlights the clinical significance of coagulation and fibrinolytic responses, and adaptations in healthy individuals and patients with cardiovascular disease (CVD). Much of the review focuses on indicators of the potential for coagulation and fibrinolysis. The terms 'coagulation potential' and 'fibrinolytic potential' are used frequently, as much of the literature in the area of exercise haemostasis evaluates factors that reflect an increased potential for coagulation, while coagulation per se, may or may not be occurring. Similarly, fibrinolysis is definitively the lysis of inappropriate or excessive blood clot, which may or may not be occurring when the enzymes that stimulate fibrinolysis are activated. Nevertheless, markers of coagulation and fibrinolytic potential are associated with CVD, ischaemic events, and cardiovascular mortality. Additionally, fibrinolytic potential is associated with other established CVD risk factors. Ischaemic events triggered by physical exertion are more likely to occur due to an occlusive thrombus, suggesting the exercise-induced responses related to haemostasis are of clinical significance. The magnitude of increase in coagulation potential, platelet aggregation and fibrinolysis appears to be primarily determined by exercise intensity. Patients with CVD may also have a larger increase in coagulation potential during acute exercise than healthy individuals. Additionally, the magnitude of the fibrinolytic response is largely related to the resting fibrinolytic profile of the individual. In particular, high resting plasminogen activator inhibitor-1 may diminish the magnitude of tissue plasminogen activator response during acute exercise. Therefore, acute responses to exercise may increase the risk of ischaemic event. However, chronic aerobic exercise training may decrease coagulation potential and increase fibrinolytic potential in both healthy individuals and CVD patients. Due to the aforementioned importance of resting fibrinolysis on the fibrinolytic response to exercise, chronic aerobic exercise training may cause favourable adaptations that could contribute to decreased risk for ischaemic event, both at rest and during physical exertion.

Blood coagulation and fibrinolysis after extreme short-term exercise

INTRODUCTION

Maximal exercise may be a trigger for cardiovascular events. The aim of the study was to investigate changes in blood coagulation and fibrinolysis following maximal short-term exercises with different durations up to 90 s.

METHODS

A total of 15 healthy nonsmokers underwent three isokinetic maximal tests on an SRM cycle ergometry system with durations of 15, 45, and 90 s. Blood samples were taken after a 30-min rest, immediately before and after exercise, 15 min, and 1 h after completion of exercise. For the investigation of blood coagulation, prothrombin fragment 1+2 (F1+2), thrombin-antithrombin III complex (TAT), intrinsic and extrinsic total (TTPin+ex), and endogenous thrombin potential (ETPin+ex) were measured. For testing fibrinolysis, determinations of plasmin-alpha(2)-antiplasmin complex (PAP), tissue-type plasminogen activator (tPA)-antigen, plasminogen activator inhibitor (PAI)-1-antigen and D-dimer were used.

RESULTS

Immediately after the exercise tests, only F1+2 (15- and 90-s test) and TTPin (45 and 90 s) showed a moderate increase (p<0.05), while TAT and ETP was unchanged. In contrast, a clear increase in PAP and tPA-antigen already after 15 s maximal exercise in relation to the exercise duration time could be investigated. These effects were not totally reversed to baseline 15 min after exercise; D-dimer and PAI-1-antigen still remained unchanged after these types of exercise.

CONCLUSIONS

Maximal short-term exercise does not lead to a relevant activation of blood coagulation in healthy young subjects, it is only slightly altered within the normal range. In contrast, fibrinolysis is clearly activated, and the increase is directly dependent on exercise duration. Additionally, it could be shown for the first time that fibrinolysis is already activated after 15 s maximal exercise duration.