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RESEARCH PRODUCT

Antiplatelet Therapy in Marathon Runners: More Harm than Benefits?

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We read with interest the article by Arthur J. Siegel, who recently concluded that prophylactic aspirin for primary prevention of cardiac events in marathon runners may be a viable approach for lowering the global risk of cardiovascular events in these subjects. Although there is a credible hysiological basis for supporting this provocative suggesion, and the use of nonsteroidal anti-inflammatory drugs is requent in athletes, there are, however, some issues that hould be considered, and which would globally overwhelm he hypothetical advantages of antiplatelet therapy in this eculiar setting. First, there is no controlled, randomized study that has efinitely proven the existence of any potential benefit of spirin administration against the risk for acute cardiac vents during marathon running or other forms of strenuous ndurance exercise. Thus, the hypothetical advantages for revention of acute thrombosis remain elusive and mostly nproven. Then, antiplatelet therapy is typically adminisered on the basis of a fine balance between antithrombotic ffect and bleeding complications. Hemorrhage is nothing ut rare in endurance athletes. McCabe et al prospectively tudied the participants of the Eighth Annual Marine Corps arathon and found a significant association between gasrointestinal blood loss and long-distance running, with one ourth of participants exhibiting a positive hemoccult test. Additional cases of clinically significant bleeding have been reported in marathon runners, including exercise-induced