Evidence map›Paper›PMID 32537688›Full record

Trial reportEuropean journal of applied physiology2020

Additive effect of erythropoietin use on exercise-induced endothelial activation and hypercoagulability in athletes.

Jules A A C Heuberger, Jelle J Posthuma, Dimitrios Ziagkos, Joris I Rotmans, Johannes M A Daniels, Pim Gal, Frederik E Stuurman, Henri M H Spronk, Hugo Ten Cate, Jacobus Burggraaf and 2 more

Open access · hybridAbstract readRandomized Controlled Trial
In one paragraph

Trial report in European journal of applied physiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.1field-weighted citation impact, top 53% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Erythropoiesis-Targeted Doping in Sports: From Improved Oxygen Transport to Cardiovascular Risk.Pathophysiology : the official journal of the International Society for Pathophysiology · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors at 4 institutions in 1 country.

Jules A A C HeubergerCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands. jheuberger@chdr.nl.ORCID http://orcid.org/0000-0001-7202-5088
Jelle J PosthumaDepartments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Dimitrios ZiagkosCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Joris I RotmansDepartment of Internal Medicine, Leiden University Medical Centre, Leiden, The Netherlands.
Johannes M A DanielsDepartment of Pulmonary Diseases, VU University Medical Centre, Amsterdam, The Netherlands.
Pim GalCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Frederik E StuurmanCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Henri M H SpronkDepartments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Hugo Ten CateDepartments of Internal Medicine and Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
Jacobus BurggraafCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Matthijs MoerlandCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Adam F CohenCentre for Human Drug Research, Zernikedreef 8, 2333 CL, Leiden, The Netherlands.
Centre for Human Drug Research · NLMaastricht University · NLLeiden University · NLAmsterdam UMC Location Vrije Universiteit Amsterdam · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRecombinant human erythropoietin (rHuEPO) is known to increase thrombotic risk in patients and might have similar effects in athletes abusing the drug. rHuEPO is prohibited by anti-doping legislation, but this risk has not been investigated thoroughly. This analysis was designed to evaluate whether rHuEPO impacts hemostatic profile and endothelial and platelet activation markers in trained subjects, and whether the combination with exercise affects exercise induced alterations.

methodsThis double-blind, randomized, placebo-controlled trial enrolled healthy, trained male cyclists aged 18-50 years. Participants were randomly allocated (1:1) to receive subcutaneous injections of rHuEPO (epoetin-β; mean dose 6000 IU per week) or placebo (0.9% NaCl) for 8 weeks. Subjects performed five maximal exercise tests and a road race, coagulation and endothelial/platelet markers were measured at rest and directly after each exercise effort.

resultsrHuEPO increased P-selectin (+ 7.8% (1.5-14.5), p = 0.02) and E-selectin (+ 8.6% (2.0-15.7), p = 0.01) levels at rest. Maximal exercise tests significantly influenced all measured coagulation and endothelial/platelet markers, and in the rHuEPO group maximal exercise tests led to 15.3% ((7.0-24.3%), p = 0.0004) higher E-selectin and 32.1% ((4.6-66.8%), p = 0.0207) higher Platelet factor 4 (PF4) levels compared to the placebo group.

conclusionIn conclusion, rHuEPO treatment resulted in elevated E- and P-selectin levels in trained cyclists, indicating enhanced endothelial activation and/or platelet reactivity. Exercise itself induces hypercoagulability, and the combination of rHuEPO and exercise increased E-selectin and PF4 levels more than either intervention alone. Based on this, exercise potentially increases thrombotic risk, a risk that might be enhanced in combination with rHuEPO use.

Indexed as

ExerciseAdultAthletesBlood CoagulationEndothelium, VascularErythropoietinHumansMaleMiddle AgedPlatelet ActivationSelectinsErythropoietinSelectinsCoagulationEndothelial activationErythropoietinExerciseHemostasis

Identifiers

PMID32537688
PMCPMC7340646
OpenAlexW3034342569

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.