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

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.