Effect of acute strenuous exercise on platelet aggregation, thrombin generation and fibrinolysis in patients with coronary artery disease

Abstract

Abstract Introduction Acute strenuous exercise may cause coronary thrombosis and sudden cardiac death. Purpose To investigate the effect of acute strenuous exercise on platelet aggregation, thrombin generation and fibrinolysis in patients with stable coronary artery disease (CAD) and healthy individuals. Method Patients with stable CAD (n=164) and healthy individuals (n=25) performed acute strenuous exercise on a cycle ergometer until exhaustion. Blood samples were taken at baseline (before exercise), immediately after and 2 hours after acute strenuous exercise. Results From baseline to immediately after strenuous exercise, TRAP-induced platelet aggregation increased significantly in CAD patients (Δ77 AU×min, 95% confidence interval (CI): 55;98, p<0.001) and also in healthy individuals (Δ153 AU×min, 95%CI: 103;225, p<0.001), and remained slightly elevated 2 hours after strenuous exercise in both groups (CAD patients: Δ53 AU×min, 95%CI: 27;80, p<0.001; healthy individuals: Δ140 AU×min, 95%CI: 56;225, p=0.002). Thrombin generation was not affected immediately after exercise, but decreased after 2 hours in patients with CAD (endogenous thrombin potential: Δ-5%, 95%CI: -9;-2, p=0.004). Fibrin clot lysis time increased immediately after exercise (CAD patients: Δ10%, 95%CI: 3-16, p=0.003; healthy individuals: Δ30%, 95%CI: 16;46, p<0.001), whilst plasminogen activator inhibitor-1 (PAI-1) decreased (CAD patients: Δ-17%, 95%CI: -33;-10, p<0.001; healthy individuals: Δ-40%, 95%CI: -53;-25, p<0.001). After 2 hours, an increased fibrinolysis was seen in both groups, expressed as a decrease in PAI-1 in both groups (CAD patients: Δ-41%, 95%CI: -46;-35 p<0.001; healthy individuals: Δ-64%, 95%CI: -75;-46, p<0.001) and a reduced fibrin clot lysis time in patients with CAD (Δ-18%, 95%CI: -24;-11, p<0.001). Conclusions Acute strenuous exercise induced an immediate increase in platelet aggregation. Platelet aggregation remained slightly elevated after 2 hours while fibrinolysis was increased and thrombin generation slightly decreased indicating a more favourable haemostatic profile after 2 hours.