INFLUENCE OF CHANGES IN LIFE-STYLE ON FIBRINOLYTIC PARAMETERS AND RECURRENCE RATE IN PATIENTS WITH VENOUS THROMBOEMBOLISM

A prospective, non-randomized, interventional study was carried out to evaluate the effect of changes in lifestyle on abnormal fibrinolytic parameters, and the influence of those, in turn, on the risk of recurr ence among patients with venous thromboembolism. Patients with elevate d plasminogen activator inhibitor 1 (PAI-1) levels or decreased releas e of tissue plasminogen activator (t-PA) antigen were given informatio n and advice about improved diet, increased physical activity, weight loss and/or cessation of smoking. Totally 144 patients (119 with eleva ted PAI-1 and 25 with deficient t-PA release) were followed with repea ted analyses of the fibrinolytic parameters for a median of 8 months a fter the initial advice, and 65% of the patients managed to execute at least one change in their lifestyle. The reduction of PAI-1 activity after one, two and three changes in lifestyle were -2.4, -10.0 and -14 .0 AU/ml (-10, -30 and -48% of baseline activity), respectively. Those who accomplished two or three changes in their lifestyle had a greate r chance of normalizing the PAI-1 level than those with no or only one change (P = 0.009). The effects of improved diet, weight loss and inc reased physical activity on the PAI-1 level were of a similar magnitud e, -7.0 to -10.4 AU/ml (24-32% reduction). The effect on t-PA release was more difficult to evaluate due to the limited number of those pati ents. After a follow-up of 6 years (mean) after the first visit the pa tients were enquired about recurrent events, with a response rate of 8 6%. There was no detectable effect of the improvement of PAI-1 levels on the risk of recurrent thromboembolism. Thus, although it is possibl e to modify the abnormalities in the fibrinolytic parameters through c hanges in lifestyle, this in turn will not have any remarkable effect on the risk of new thromboembolic events in patients with initial veno us thromboembolism.