Acute and subacute effects of strenuous exercise on platelet aggregation, coagulation and fibrinolysis in patients with stable coronary artery disease
Jacobina Kristiansen a),b),c),d); Erik L. Grove c),d); Tórur Sjúrðarson e),f); Magni Mohr e),g); Steen D. Kristensen c),d); Anne-Mette Hvas d)
a) Department of Medicine, National Hospital of the Faroe Islands, T´orshavn, Faroe Islands.
b) Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
c) Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark.
d) Faculty of Health, Aarhus University, Aarhus, Denmark.
e) Center of Health Science, Faculty of Health, University of the Faroe Islands, T´orshavn, Faroe Islands.
f) Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
g) Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark
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.