Acute and subacute effects of strenuous exercise on platelet aggregation, coagulation and fibrinolysis in patients with stable coronary artery disease

Jacobina Kristiansen, Erik L. Grove, Tórur Sjúrðarson, Magni Mohr, Steen D. Kristensen, Anne-Mette Hvas

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Abstract

Introduction: Strenuous exercise may occasionally cause coronary thrombosis with myocardial infarction and
sudden cardiac death.
Materials and methods: Patients with stable coronary artery disease (CAD) (n = 164) and healthy individuals (n =
25) performed strenuous exercise on a bicycle ergometer. Blood was drawn at baseline, immediately after exercise
and 2 h later. Platelet aggregation was measured with Multiplate® Analyzer. Thrombin generation was
determined using a thrombogram and by measuring prothrombin fragment 1 + 2 (F1 + 2). A clot lysis assay was
used to investigate fibrinolysis.
Results: From baseline to immediately after exercise, thrombin receptor activating peptide (TRAP)-induced
platelet aggregation increased in CAD patients (Δ77 AU × min, 95 % confidence interval (CI): 46;107) and in
healthy individuals (Δ153 AU × min, 95%CI: 75;232). Endogenous thrombin potential (ETP) was unaffected by
exercise, whilst F1 + 2 increased (Δ17%, 95%CI: 11;24) in CAD patients. Fibrin clot lysis time increased by 9 %
(95%CI: 1–17) in CAD patients and by 26 % (95%CI: 8;45) in healthy individuals. When comparing baseline to 2
h post-exercise, TRAP-induced platelet aggregation remained slightly elevated in both CAD patients (Δ53 AU ×
min, 95%CI: 22;84) and healthy individuals (Δ140 AU × min, 95%CI: 62;219). In contrast, ETP and F1 + 2
decreased in CAD patients (Δ-6 %, 95%CI: 􀀀 10;-1 and Δ-8 %, 95%CI: -14;-2). Moreover, clot lysis time decreased
(Δ-19 %, 95%CI: 􀀀 27;-11) in patients with CAD and returned to baseline in healthy individuals. All p-values were
<0.05.
Conclusions: Platelet aggregation and F1 + 2 were substantially elevated immediately after exercise in CAD
patients, indicating a pro-thrombotic state. After 2 h of recovery, they exhibited a markedly increase in fibrinolysis.
Similar results were observed in healthy individuals.
Original languageEnglish
Pages220-227
Number of pages8
Volume236
Specialist publicationThrombosis Research
Publication statusPublished - 5 Mar 2024

Keywords

  • Exercise test
  • Coronary artery disease
  • Platelet aggregation
  • Blood coagulation
  • Fibrinolysis

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