Pro-coagulant activity during exercise testing in patients with coronary artery disease

Joanna Cwikiel, Ingebjorg Seljeflot, Eivind Berge, Harald Arnesen, Kristian Wachtell, Hilde Ulsaker, Arnljot Flaa, Joanna Cwikiel, Ingebjorg Seljeflot, Eivind Berge, Harald Arnesen, Kristian Wachtell, Hilde Ulsaker, Arnljot Flaa

Abstract

Background: Strenuous exercise may trigger myocardial infarction through increased pro-coagulant activity. We aimed to investigate whether patients referred for exercise testing, who were found to have angiographically verified coronary artery disease (CAD), have a more hypercoagulable profile during exercise testing than those without CAD.

Methods: Patients with symptoms of stable CAD were examined with exercise electrocardiography on bicycle ergometer. Venous blood samples were taken at rest and within 5 min after end of exercise. The following haemostatic variables were analyzed: tissue factor pathway inhibitor (TFPI) activity and antigen, prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). All participants underwent conventional coronary angiography. CAD was defined as having any degree of atherosclerosis.

Results: Out of the 106 patients enrolled, 70 were found to have CAD. Mean exercise duration was 10:06 ± 4:11 min, with no significant differences between the groups. A significant increase from baseline to after exercise testing was observed in all measured markers in the total population (p ≤ 0.002 for all). In patients with angiographically verified CAD, total TFPI was significantly lower at baseline compared to patients without CAD (median value 67.4 and 76.6 ng/ml respectively, p = 0.027). However, no significant differences in changes of any of the measured markers during exercise were observed between the two groups.

Conclusion: Pro-coagulant activity increased during short-term strenuous exercise testing in patients with symptoms suggestive of CAD. However the hypercoagulable state observed, was not more pronounced in patients with angiographically verified CAD compared to patients without CAD. NCT01495091.

Keywords: Angina; Atherosclerosis; Coagulation; Coronary angiography; Exercise testing.

Figures

Fig. 1
Fig. 1
Levels of haemostatic markers before and after exercise in the total population (unadjusted for hematocrit). P-value refers to change from before to after exercise. The error bars on graphs represents 25th and 75th percentiles
Fig. 2
Fig. 2
Changes in haemostatic markers during exercise in patients with angiographically verified CAD and no CAD (unadjusted for hematocrit). P-value refers to difference in change between groups. The error bars on graphs represents 25th and 75th percentiles. ns = non-significant

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