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The interpretations below are provided by Donna Castellone, MS, MT (ASCP) SH for Aniara Diagnostica.

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Here we are again, the month of October which takes a global look at thrombosis and how we can combat against its occurrence. This year the theme is "Move Against Thrombosis". A World Thrombosis Day study determined that 10 million diagnosed cases of blood clots occur annually across low, middle, and high income countries.¹ The goal of this organization is to raise awareness of risk factors, signs and symptoms and educate the community to urge everyone to Move Against Thrombosis!

Physical activity:

A meta-analysis looked at 14 cohort studies that included 1,286,295 participants in which 23,753 were VTE eligible and compared the most physically active versus the least. Data supported an association between regular physical activity and low incidence of VTE, and it doesn't appear to be mediated or confounded by BMI.² The benefit of physical activity includes improvement in endothelial function as well as levels of cardiovascular risk factors such as body weight, blood pressure, lipids, glucose, hemostasis, inflammation and enhancement of cardiac function.³ The pathogenesis of VTE include inflammation, endothelial dysfunction, alterations in blood flow, immobilization and hypercoagulable states and physical activity is known to have beneficial effects on these states.⁴ VTE is linked with arterial thrombotic disease, which is a public health burden that includes increased morbidity, premature mortality, hospitalization and increased health care costs.⁴

One analysis showed that physical activity and sedentary time were independently associated with the risk of VTE. There were 7 studies that included 101,153 participants with 4234 VTE events. Prolonged sedentary behavior was associated with an increased VTE risk (OR = 1.24, 95%CI: 1.05–1.47). The review showed a reduced risk of VTE with higher levels of activity and an increased risk of VTE with higher levels of sedentary behavior with a 2% higher risk of VTE with every 1 h increment of sedentary behavior per day. A subgroup analysis showed that the VTE risk was attenuated after BMI adjustment but remained significant, and the effect of activity was somewhat stronger in those with higher BMI. The protective effect of activity tended to persist after adjusting for sedentary behavior.⁵

Coagulation parameters during activity

Strenuous exercise can lead to platelet activation, but regular physical activity can diminish or prevent platelet activation. There is a relationship between vigorous exercise and the risk for MI and a physically active lifestyle that reduces cardiovascular mortality. Catecholamine, shear and oxidative stress are increased during acute exercise all of which activate platelets. There is also stimulated endothelial production of nitric oxide and counteracts platelet activation resulting in vessel dilation and increased blood flow at lower shear.⁶

Plasma fibrinogen concentrations were looked at in 23,201 subjects aged 40-76 years. Mean fibrinogen concentrations were lower in people who were physically active (2.82±0.02) than those less active (2.97±0.02g/L) in men and 2.95±0.02 in active women versus 3.04±0.01g/L in inactive women. Both were statistically significant and support the health benefits of physical activity.⁷

Hypercoagulability is seen in acute exercise due to high levels of Factor VIII, thrombin–antithrombin III complex (TAT), prothrombin fragments 1 and 2 (F1 + F2), fibrinogen, and fibrinopeptide A, as well as shorter activated partial thromboplastin time (aPTT) and nonactivated partial thromboplastin durations. When compared to sedentary subjects, those who are physically trained have decreased vWF antigen and activity, endogenous thrombin potential (ETP), fibrinogen antigen, and F1 + F2, and shortened or equal clotting times (aPTT, PT, and thrombin time—TT). Other factors include tissue factor pathway inhibitor (TFPI) and tissue factor (TF). TFPI is a procoagulant protein inhibitor that has a time-of-day effect with increased activity during the morning in a rest state. At this time fibrinolysis is less active, however later in the day coagulation becomes more active and can predispose individuals to hypercoagulability and cardiovascular events.

Fibrinolysis is also increased most likely due to the increased rate of tPA from vascular endothelial cells. A drop in PAI-1 is seen due to a decrease in renal blood flow as well as less clearance of tPA by the liver.⁸

Many of the mechanisms cannot explain the observation however several physiological mechanisms support the potential effect of activity and the prevention of VTE. This can be due to the improved circulation of blood vessels lowering the odds of decreased blood flow to the legs. Physical activity could protect due to a reduction in anti-inflammatory processes that can be increased due to sitting. Additionally, muscle contractions can be weakened affecting the metabolism and blood vessel health leading to VTE.

Here are 10 easy ways to Move Against Thrombosis

1. Go on a walk outside either on your own or with a loved one.
2. Set a timer to stand up and stretch once an hour for five minutes.
3. Try a new workout or exercise regimen. Search for new workout videos online or sign up for a class at a local gym.
4. If sitting for long periods while working, try a standing desk set-up or take a break from work to stand and stretch frequently.
5. Join a walking challenge. Walking challenges can be virtual or in-person; they are a great way to stay motivated and meet movement goals.
6. Dance! Take 10 minutes of the day to dance at home with your children, friends or loved ones. Dancing is a great way to move and increase circulation.
7. Take breaks on a road trip. If sitting in the car for long periods, stop each hour to get out of the car and walk around for a few minutes.
8. If you are a healthcare professional, encourage patients to incorporate at least 30 minutes of movement into their daily routine to lower their blood clot risk.
9. Raise your legs six inches above your heart from time to time. This helps to increase blood flow.
10. Take a yoga class to move your body and relax your mind.¹

CONCLUSION:

The purpose of World Thrombosis Day is to provide research and publications to increase awareness as well as the prevention and diagnosis of thrombotic conditions. This is the global campaign of the International Society on Thrombosis and Hemostasis. October 13 is dedicated to the annual public awareness of this condition.

REFERENCES:

1. https://www.worldthrombosisday.org/take-action/move-against-thrombosis/
2. Kunutsor SK, Mäkikallio TH, Seidu S, de Araújo CGS, Dey RS, Blom AW, Laukkanen JA. Physical activity and risk of venous thromboembolism: systematic review and meta-analysis of prospective cohort studies. Eur J Epidemiol. 2020 May;35(5):431-442.
3. Cheng W, Zhang Z, Cheng W, Yang C, Diao L, Liu W. Associations of leisure-time physical activity with cardiovascular mortality: a systematic review and meta-analysis of 44 prospective cohort studies. Eur J Prev Cardiol. 2018;25(17):1864–1872
4. Wendelboe AM, Raskob GE. Global burden of thrombosis: epidemiologic aspects. Circ Res. 2016;118(9):1340–1347.
5. Wang, G., Han, B., Dai, G. et al. Role of physical activity and sedentary behavior in venous thromboembolism: a systematic review and dose-response meta-analysis. Sci Rep 14, 22088 (2024).
6. Heber S, Volf I. Effects of Physical (In)activity on Platelet Function. Biomed Res Int. 2015;2015:
7. Myint, Phyo K. et al., Physical activity and fibrinogen concentrations in 23,201 men and women in the EPIC-Norfolk population-based study Atherosclerosis, Volume 198, Issue 2, 419 – 425
8. Skouras AZ, Antonakis-Karamintzas D, Tsantes AG, Triantafyllou A, Papagiannis G, Tsolakis C, Koulouvaris P. The Acute and Chronic Effects of Resistance and Aerobic Exercise in Hemostatic Balance: A Brief Review. Sports (Basel). 2023 Mar 27;11(4):74.



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