Influence of long-distance trail running on blood hemostasis at the World Mountain Trail Running Championship 2023-a pilot study.

BACKGROUND

Severe exercise performed over longer duration can involve multiple prothrombotic alterations in blood coagulation markers. Standard coagulation tests are not robust in identifying hyper- or hypocoagulability due to indirect determination of changes in hemostasis and fibrinolysis. Conversely, viscoelastic tests might do so.

OBJECTIVES

The aim of this pilot study was to assess the exercise-induced changes in coagulatory and fibrinolytic processes by applying viscoelastic tests in a mountain ultramarathon. Seven elite athletes participating in the World Mountain and Trailrunning Championship 2023 were examined. The 86.9 km track involved 6500 m of climbing and 6920 m of descent.

METHODS

Venous blood samples were taken the day prior to and within 3 hours following the competition. Plasma coagulation tests and whole blood viscoelastic coagulation tests (ClotPro) were used to assess changes in hemostasis.

RESULTS

Plasma coagulation testing revealed prolonged prothrombin time, with correlatively decreased factor (F)V, FVII, and FX activities. As a consequence of increased intrinsic coagulation factor activities (FVIII, FIX, FXI, and FXII) and von Willebrand factor, activated partial thromboplastin time was shortened. In addition, plasminogen decreased, whereas α2-antiplasmin and D-dimer showed significant elevations. Maximal lysis, examined by viscoelastometric tests, was observed to be slightly diminished postrace, whereas fibrin polymerization increased.

CONCLUSION

The trail-long race generated substantial alterations in coagulation that were linked to a higher inflammatory state, with characteristic increases in FVIII, von Willebrand factor, and fibrinogen levels. Viscoelastic coagulation monitoring used in our study was able to reflect the summation of pro- and anticoagulants, as well as pro- and antifibrinolytic changes, in hemostasis.