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

Objective: Air travel and exercise change hemostatic parameters. This study investigated the effect of air travel on exercise-induced coagulation and fibrinolysis in endurance athletes. Design: A prospective longitudinal study. Setting: The 114th Boston Marathon (April 19, 2010). Participants: Forty-one adults were divided into travel (T: 23 participants, living > 4-hour plane flight from Boston) and nontravel (C: 18 participants, living < 2-hour car trip from Boston) groups. Independent Variables: Age, anthropometrics, vital signs, training mileage, and finishing time were collected. Main Outcome Measures: Subjects provided venous blood samples the day before (PRE), immediately after (FINISH), and the day following the marathon after returning home (POST). Blood was analyzed for thrombin-antithrombin complex (TAT), tissue plasminogen activator (t-PA), hematocrit (Hct), and the presence of Factor V Leiden R506Q mutation. Results: Thrombin-antithrombin complex increased more in T subjects in PRE to FINISH samples (5.0 +/- 4.0 to 12.9 +/- 15.6 mg/L) than in C subjects (4.0 +/- 1.2 to 6.1 +/- 1.2 mg/L; P = 0.02 for comparison). The t-PA increased in both the T (5.4 +/- 2.3 to 25.1 +/- 12.2 ng/mL) and C (5.6 +/- 2.0 to 27.7 +/- 11.3 ng/mL) groups in PRE to FINISH samples, and this response did not differ between groups (P = 0.23 for comparison). Both groups exhibited similar t-PA and TAT values at POST that were not different than PRE (all P > 0.35). Age was related to the FINISH TAT values in T (r(2) = 0.19; P = 0.04) but not in C (r(2) = 0.03; P = 0.53) subjects. Conclusions: Results suggest that the combination of air travel and marathon running induces an acute hypercoaguable state; this hemostatic imbalance is exaggerated with increasing age.