ACTIVATION OF COAGULATION AND FIBRINOLYSIS AFTER REHABILITATIVE EXERCISE IN PATIENTS WITH CORONARY-ARTERY DISEASE

It has been suggested that blood coagulation be activated and fibrinol ytic activity be impaired in patients with coronary artery disease (CA D). With regard to the activation of coagulation and fibrinolysis occu ring during exercise in healthy individuals, we examined the hypothesi s that rehabilitative exercise in patients with CAD might give rise to an exaggerated activation of coagulation. In 12 patients with angiogr aphically documented CAD without myocardial infarction within the prec eding 6 months (male, age 55 +/- 9 years [SD]) and in 12 healthy contr ols (male, 52 +/- 7 years), molecular markers of thrombin, fibrin, and plasmin formation were determined before and after a rehabilitative g roup exercise session lasting 1 hour. Resting levels of prothrombin fr agment 1 + 2 were lower in patients with CAD (0.67 +/- 0.2 [SE] vs 1.0 4 +/- 0.2 nmol/L, p <0.001) and remained unchanged after exercise, whe reas a significant increase was noted in controls (p <0.01). After exe rcise, plasma levels of thrombin-antiihrombin III complexes and of fib rinopeptide A increased significantly in both groups, although there w ere more pronounced changes In controls. Exercise resulted in a marked generation of plasmin as indicated by plasmin-alpha 2-antiplasmin com plexes increasing 2.5-fold in patients (p <0.001) and threefold in con trols (p <0.001). Repeated experiments in control subjects after admin istration of aspirin (day 1:500 mg; days 2 to 5:100 mg) documented tha t differences between groups could not be attributed to aspirin medica tion (100 mg/day) in patients with CAD. We concluded that rehabilitati ve exercise in patients with CAD beyond the immediate postinfarction p eriod has no detrimental effects on thrombin, fibrin, and plasmin form ation. (C) 1998 by Excerpta Medico, Inc.