Sudden Death Events At Marathons
Sudden cardiac or heart events isn’t our usual areas of focus. Nor is it our speciality. But we came across a series of interesting materials recently that we thought is interesting, if not important, to our readers and clients who are serious athletes. More so, given the the fact there has a been a spat of cardiac-related deaths at recent triathlon and marathon events here in Singapore; particularly young athletes who previously had no symptoms of any heart problems.
Recent studies have been pointing to increased activation of coagulation and platelets depends on the type of endurance sport and running fraction. The results seem to be indicate that running activates both coagulation and platelet activity, resulting in an increased risk of thromboembolic (a clot in a blood vessel) incidents in running athletes (1,2). This leads to the inevitable question, what can we do about it?
Dr. Lewis G. Maharam (The Running Doc) suggests in his column in Runners World to take a daily does of baby Aspirin (4). He cites a recent clinical guideline by U.S. Preventive Services Task Force (USPSTF) recommendation about the use of aspirin for the prevention of coronary heart disease (3). Baby aprisin is a low-dose of aspirin.
Though in a later article, Dr. Maharam states there are no clear guidelines as to when to take the aspirin (5). He wrote, “When to take the baby aspirin is being debated, and there is no clear answer. Whether to take it daily, every other day, every three days, or just the morning of the marathon, I am sure will be discussed and debated in the medical community until further research comes to light.”
Further reading into the USPSTF guidelines indicates that it does NOT encourage aspirin use for cardiovascular disease prevention in women younger than 55 years and in men younger than 45 years. This is because there is moderate certainty that the potential benefits of reducing myocardial infarction in men or ischemic stroke in women do NOT outweigh the harms of aspirin use. However, the risk of an adverse cardiovascular episode are much higher in marathon events compared to daily activities. In this case, the benefits of taking baby aspirin may outweigh the harm. Please seek your doctor’s or sports medicine specialist’s advice on this.
Clearly, more studies need to be done and better solutions needed. At least, it sheds some light on to what might have happen in the past. Always check with your doctors before starting on any measures suggested here.
Whole blood coagulation and platelet activation in the athlete: a comparison of marathon, triathlon and long-distance running, Critical Care 2008, 12(Suppl 2):P209 A Hanke, A Staib, K Görlinger, M Perrey, D Dirkmann and P Kienbaum
Effects of Marathon Running on Platelet Activation Markers, American Journal of Clinical Pathology, Alexander Kratz, MD, PhD, MPH; Malissa J. Wood, MD; Arthur J. Siegel, MD; Jennifer R. Hiers, MT; Elizabeth M. Van Cott, MD
Aspirin for the Prevention of Cardiovascular Disease: U.S. Preventive Services Task Force Recommendation Statement, U.S. Preventive Services Task Force