Schobersberger Wolfgang, Tobiasch Anna Katharina, Dünnwald Tobias, Köck Anika, Schobersberger Beatrix, Adami Paolo Emilio, Garrandes Frederic, Bermon Stephane, Weiss Günter, Irsara Christian, Treml Benedikt, Fries Dietmar
Institute for Sports Medicine, Alpine Medicine and Health Tourism, Private University for Health Sciences and Health Technology, Private University for Health Sciences and Health Technology (UMIT Tirol), Hall in Tyrol, Austria.
Institute for Sports Medicine, Alpine Medicine and Health Tourism, University Hospital/Tirol Kliniken, Innsbruck, Austria.
Res Pract Thromb Haemost. 2025 Jun 30;9(5):102958. doi: 10.1016/j.rpth.2025.102958. eCollection 2025 Jul.
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.
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.
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.
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.
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.
长时间进行的剧烈运动可导致血液凝固标志物出现多种促血栓形成改变。标准凝血试验在识别由于止血和纤维蛋白溶解变化的间接测定而导致的高凝或低凝状态方面并不可靠。相反，粘弹性试验可能能够做到这一点。
本初步研究的目的是通过在山地超级马拉松中应用粘弹性试验来评估运动引起的凝血和纤维蛋白溶解过程的变化。对7名参加2023年世界山地与越野跑锦标赛的精英运动员进行了检查。这条86.9公里的赛道包括6500米的爬坡和6920米的下坡。
在比赛前一天和比赛后3小时内采集静脉血样。采用血浆凝血试验和全血粘弹性凝血试验（ClotPro）评估止血变化。
血浆凝血试验显示凝血酶原时间延长，因子（F）V、FVII和FX活性相应降低。由于内源性凝血因子活性（FVIII、FIX、FXI和FXII）和血管性血友病因子增加，活化部分凝血活酶时间缩短。此外，纤溶酶原减少，而α2-抗纤溶酶和D-二聚体显著升高。通过粘弹性试验检测，赛后最大溶解略有减少，而纤维蛋白聚合增加。
超长距离越野赛导致凝血发生显著改变，这与较高的炎症状态有关，FVIII、血管性血友病因子和纤维蛋白原水平有特征性升高。我们研究中使用的粘弹性凝血监测能够反映止血过程中促凝剂和抗凝剂以及促纤溶和抗纤溶变化的总和。
