Effects of strenuous exercise on haemostasis

Objectives: To review the effects of exercise on haemostasis and examine the possible clinical sequelae of these changes. Methods: The search strategy included articles from 1966 to August 2002 using Medline and SportDiscus databases, and cross referencing the bibliographies of relevant papers. Results: Exercise results in activation of both the coagulation and fibrinolytic cascades, as shown by a reduction in whole blood clotting time and activated partial thromboplastin time, an increase in the activity of several components of the cascades, and an increase in fibrin degradation products. In vitro tests suggest that coagulation remains activated after fibrinolysis has returned to baseline levels. Conclusions: Both the coagulation and fibrinolytic cascades are stimulated by strenuous exercise, but the temporal relation between the two and its clinical significance remains to be clarified. Doctors and athletes should be aware of the haemostatic changes induced by exercise, and further work is needed to clarify the possible role of these changes in sudden cardiac death.