{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:59:28Z","timestamp":1781243968379,"version":"3.54.1"},"reference-count":57,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Increases in hemostatic markers, indicators of thrombotic risk, have been reported following strenuous exercise; however, determinants of these responses remain poorly understood. This study aimed to determine whether supplementation with hydrolytic enzymes and flavonoids (Wobenzym\n                      <jats:sup>\u00ae<\/jats:sup>\n                      [WOB]) modulates exercise-induced hemostatic responses in marathon runners and to identify factors associated with these changes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This predefined subanalysis of the Enzy-MagIC trial was conducted within a prospective, randomized, double-blind, placebo-controlled trial. Participants were randomized (1:1) to receive WOB (rutoside 600\u20131200 mg\/day, bromelain 540\u20131080 mg\/day, trypsin 288\u2013576 mg\/day) or placebo for 1 week before and 2 weeks post-race, following a predefined dosing regimen. Blood samples were collected at baseline, immediately, 24 h, and 72 h post-race for analysis of D-dimer, plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), prothrombin fragment 1 + 2 (F1+2), thrombin generation (calibrated automated thrombography; CAT: lag time, peak thrombin, endogenous thrombin potential [ETP]), maximal platelet aggregation induced by adenosine diphosphate (MPADP), and platelet count.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 118 male runners (age 42 \u00b1 11 years; WOB n = 64, placebo n = 54), no differences were observed between groups for any hemostatic marker (all p&amp;gt;0.05). D-dimer, PAI-1, tPA, F1+2, MPADP, and platelet count increased immediately post-race (all p&amp;lt;0.001) and returned toward baseline within 24 h. CAT lag time and peak thrombin increased at 24 h (both p&amp;lt;0.05), whereas ETP decreased immediately post-race (p&amp;lt;0.001). In multivariable analyses, \u0394tPA was associated with finishing time and age, and \u0394CAT lag time with body fat percentage (all p&amp;lt;0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>WOB supplementation did not affect post-race hemostasis; however, marathon running induced hemostatic activation, partly driven by clinical and performance-related characteristics.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphys.2026.1843994","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:45:27Z","timestamp":1781243127000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exercise-induced changes in hemostasis markers in marathon runners: effects of enzyme supplementation and determinants"],"prefix":"10.3389","volume":"17","author":[{"given":"Julia","family":"Schoenfeld","sequence":"first","affiliation":[{"name":"Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, Technical University of Munich","place":["Munich, Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viola","family":"Grabs","sequence":"additional","affiliation":[{"name":"Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, Technical University of Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David C.","family":"Nieman","sequence":"additional","affiliation":[{"name":"Human Performance Laboratory, Appalachian State University","place":["Kannapolis, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Holdenrieder","sequence":"additional","affiliation":[{"name":"Institute of Laboratory Medicine, German Heart Centre Munich, Technical University Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Haller","sequence":"additional","affiliation":[{"name":"Insitute of AI and Informatics in Medicine, TUM School of Medicine and Health, Technical University of Munich","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Halle","sequence":"additional","affiliation":[{"name":"Department of Preventive Sports Medicine and Sports Cardiology, TUM School of Medicine and Health, Technical University of Munich","place":["Munich, Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance","place":["Munich, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johannes","family":"Scherr","sequence":"additional","affiliation":[{"name":"University Center for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich","place":["Zurich, Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1355","DOI":"10.1056\/nejm200011093431902","article-title":"Triggering of sudden death from cardiac causes by vigorous exertion","volume":"343","author":"Albert","year":"2000","journal-title":"N. 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