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Kristiansen J, Grove EL, Sjúrðarson T, Mohr M, Kristensen SD, Hvas AM. Acute and subacute effects of strenuous exercise on platelet aggregation, coagulation and fibrinolysis in patients with stable coronary artery disease. Thromb Res 2024; 236:220-227. [PMID: 38484628 DOI: 10.1016/j.thromres.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/11/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
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.
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Affiliation(s)
- Jacobina Kristiansen
- Department of Medicine, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands; Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Erik L Grove
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Tórur Sjúrðarson
- Center of Health Science, Faculty of Health, University of the Faroe Islands, Tórshavn, Faroe Islands; Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Magni Mohr
- Center of Health Science, Faculty of Health, University of the Faroe Islands, Tórshavn, Faroe Islands; Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster, University of Southern Denmark, Odense, Denmark
| | - Steen D Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Faculty of Health, Aarhus University, Aarhus, Denmark
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Physical Exercise as a Modulator of Vascular Pathology and Thrombin Generation to Improve Outcomes After Traumatic Brain Injury. Mol Neurobiol 2021; 59:1124-1138. [PMID: 34846694 DOI: 10.1007/s12035-021-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
Disruption of the blood-brain barrier and occurrence of coagulopathy after traumatic brain injury (TBI) have important implications for multiple secondary injury processes. Given the extent of post-traumatic changes in neuronal function, significant alterations in some targets, such thrombin (a protease that plays a physiological role in maintaining blood coagulation), play an important role in TBI-induced pathophysiology. Despite the magnitude of thrombin in synaptic plasticity being concentration-dependent, the mechanisms underlying TBI have not been fully elucidated. The understanding of this post-injury neurovascular dysregulation is essential to establish scientific-based rehabilitative strategies. One of these strategies may be supporting physical exercise, considering its relevance in reducing damage after a TBI. However, there are caveats to consider when interpreting the effect of physical exercise on neurovascular dysregulation after TBI. To complete this picture, this review will describe how the interactions established between blood-borne factors (such as thrombin) and physical exercise alter the TBI pathophysiology.
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Zadow EK, Wundersitz DWT, Hughes DL, Adams MJ, Kingsley MIC, Blacklock HA, Wu SSX, Benson AC, Dutheil F, Gordon BA. Coronavirus (COVID-19), Coagulation, and Exercise: Interactions That May Influence Health Outcomes. Semin Thromb Hemost 2020; 46:807-814. [PMID: 32882720 PMCID: PMC7645838 DOI: 10.1055/s-0040-1715094] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The proinflammatory cytokine storm associated with coronavirus disease 2019 (COVID-19) negatively affects the hematological system, leading to coagulation activation and endothelial dysfunction and thereby increasing the risk of venous and arterial thrombosis. Coagulopathy has been reported as associated with mortality in people with COVID-19 and is partially reflected by enhanced D-dimer levels. Poor vascular health, which is associated with the cardiometabolic health conditions frequently reported in people with severer forms of COVID-19, might exacerbate the risk of coagulopathy and mortality. Sedentary lifestyles might also contribute to the development of coagulopathy, and physical activity participation has been inherently lowered due to at-home regulations established to slow the spread of this highly infectious disease. It is possible that COVID-19, coagulation, and reduced physical activity may contribute to generate a “perfect storm,” where each fuels the other and potentially increases mortality risk. Several pharmaceutical agents are being explored to treat COVID-19, but potential negative consequences are associated with their use. Exercise is known to mitigate many of the identified side effects from the pharmaceutical agents being trialled but has not yet been considered as part of management for COVID-19. From the limited available evidence in people with cardiometabolic health conditions, low- to moderate-intensity exercise might have the potential to positively influence biochemical markers of coagulopathy, whereas high-intensity exercise is likely to increase thrombotic risk. Therefore, low- to moderate-intensity exercise could be an adjuvant therapy for people with mild-to-moderate COVID-19 and reduce the risk of developing severe symptoms of illness that are associated with enhanced mortality.
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Affiliation(s)
- Emma Kate Zadow
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | | | - Diane Louise Hughes
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.,Department of Pharmacy and Biomedical Sciences, School of Molecular Sciences, La Trobe University, Bendigo, Victoria, Australia
| | - Murray John Adams
- College of Science, Health, Engineering and Education, Murdoch University, Murdoch, Western Australia, Australia
| | - Michael Ian Charles Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia.,Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
| | | | - Sam Shi Xuan Wu
- Department of Health and Medical Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Amanda Clare Benson
- Department of Health and Medical Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Frédéric Dutheil
- Université Clermont Auvergne, CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Witty Fit, Clermont-Ferrand, France
| | - Brett Ashley Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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Sedgwick MJ, Thompson M, Garnham J, Thackray AE, Barrett LA, Powis M, Stensel DJ. Acute high-intensity interval rowing increases thrombin generation in healthy men. Eur J Appl Physiol 2016; 116:1139-48. [PMID: 27072545 PMCID: PMC4875059 DOI: 10.1007/s00421-016-3370-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/21/2016] [Indexed: 01/06/2023]
Abstract
Purpose High-intensity exercise induces several health benefits, but may acutely and transiently increase the risk of cardiovascular events due to thrombotic changes promoting blood coagulation and thrombin formation. This study examined the effects of high-intensity exercise on plasma thrombin generation and triacylglycerol concentrations. Methods Sixteen healthy men completed two, 2-day conditions separated by 1 week. On day 1, participants rested (control) or completed four, 3-min high-intensity rowing intervals at an average rating of perceived exertion of 17 (exercise). Venous blood samples were collected pre- and post-intervention to determine plasma thrombin generation. On day 2, participants rested and consumed a glucose load (0 h) and high-fat meal (2 h). Fifteen venous blood samples were collected between 0 and 8 h to measure plasma thrombin generation and triacylglycerol concentrations. Results On day 1, lag time was shorter and peak thrombin and endogenous thrombin potential were greater in the exercise than control condition (ES ≥ 0.37, main effect condition P ≤ 0.03), and post-intervention compared with pre-intervention (ES ≥ 0.49, main effect time P ≤ 0.003). The magnitude of the post-intervention change was greater in the exercise than control condition for all thrombin generation parameters (condition by time interaction P ≤ 0.05). On day 2, no differences in postprandial thrombin generation parameters were seen between conditions (P ≥ 0.21). The total area under the curve for triacylglycerol was lower in the exercise than control condition (ES = 0.34, P = 0.02). Conclusion An acute bout of high-intensity interval rowing increased plasma thrombin generation immediately after exercise, but these differences were eliminated 16–24 h after exercise.
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Affiliation(s)
- Matthew J Sedgwick
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.,Department of Sport, Health and Nutrition, Leeds Trinity University, Leeds, UK
| | - Matthew Thompson
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Jack Garnham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Alice E Thackray
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | - Laura A Barrett
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK
| | | | - David J Stensel
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, Leicestershire, LE11 3TU, UK.
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Kupchak BR, Creighton BC, Aristizabal JC, Dunn-Lewis C, Volk BM, Ballard KD, Comstock BA, Maresh CM, Kraemer WJ, Volek JS. Beneficial effects of habitual resistance exercise training on coagulation and fibrinolytic responses. Thromb Res 2013; 131:e227-34. [DOI: 10.1016/j.thromres.2013.02.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Revised: 02/13/2013] [Accepted: 02/15/2013] [Indexed: 11/25/2022]
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Galea V, Triantafyllidi H, Theodoridis T, Koutroumbi M, Christopoulou-Cokkinou V, Kremastinos D, Anastasiou-Nana M, Lekakis J. Long-term treatment with ramipril favourably modifies the haemostatic response to acute submaximal exercise in hypertensives. J Renin Angiotensin Aldosterone Syst 2012. [DOI: 10.1177/1470320312466125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Vassiliki Galea
- Haematology Laboratory, Evangelismos Hospital, Athens, Greece
| | - Helen Triantafyllidi
- 2nd Department of Cardiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Matina Koutroumbi
- 2nd Department of Cardiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | | | - Dimitrios Kremastinos
- 2nd Department of Cardiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | - Maria Anastasiou-Nana
- 2nd Department of Cardiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece
| | - John Lekakis
- 2nd Department of Cardiology, Medical School, University of Athens, Attikon Hospital, Athens, Greece
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Thrall G, Lane D, Carroll D, Lip GYH. A systematic review of the effects of acute psychological stress and physical activity on haemorheology, coagulation, fibrinolysis and platelet reactivity: Implications for the pathogenesis of acute coronary syndromes. Thromb Res 2007; 120:819-47. [PMID: 17321571 DOI: 10.1016/j.thromres.2007.01.004] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2006] [Revised: 09/28/2006] [Accepted: 01/01/2007] [Indexed: 12/18/2022]
Abstract
Physical activity and psychological stress are two potential triggers for the onset of acute coronary syndromes (ACS). To examine the mechanisms underlying this association, we systematically reviewed the literature to determine the effects of acute psychological stress and physical activity on haemorheology and haemostasis. Studies examining the haemorheological and haemostatic response to an acute bout of physical activity (i.e. <60 min) or laboratory psychological stress task were eligible for inclusion. The experimental evidence, although compromised by various methodological weaknesses, suggests that low and moderate intensity physical activity may be cardio-protective through beneficial effects on fibrinolytic system. High levels of physical activity, and psychological to a lesser extent, have been consistently associated with robust changes in haemorheology and haemostasis. Such findings imply that such activities may have the potential to trigger the onset of ACS, although in reality this may be limited sedentary individual and/or those with pre-existing vascular disease. In addition, the data also suggest that individuals may be at a greatest risk of stress-induced thrombogenesis in the period immediately following physical activity or psychological stress, rather than during the activity per se. In conclusion, psychological stress and physical activity may act as potential triggers for the onset of ACS via effects on haemostasis and haemorheology.
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Affiliation(s)
- Graham Thrall
- Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham B18 7QH, England
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