Int J Sports Med 2018; 39(08): 646-652
DOI: 10.1055/a-0631-3302
Clinical Sciences
© Georg Thieme Verlag KG Stuttgart · New York

Effect of Physical Exercise on Platelet Reactivity in Patients with Dual Antiplatelet Therapy

Stefan Brunner
1   University Hospital of Munich, Cardiology, Munich, Germany
,
Konstantinos Rizas
1   University Hospital of Munich, Cardiology, Munich, Germany
,
Wolfgang Hamm
1   University Hospital of Munich, Cardiology, Munich, Germany
,
Michael Mehr
1   University Hospital of Munich, Cardiology, Munich, Germany
,
Korbinian Lackermair
1   University Hospital of Munich, Cardiology, Munich, Germany
› Author Affiliations
Further Information

Publication History



accepted 11 April 2018

Publication Date:
14 June 2018 (online)

Abstract

It is known that physical exercise may increase platelet activity. However, the effect of exercise on platelet reactivity in patients on dual antiplatelet therapy has not been investigated yet. In our study, 21 patients with coronary artery disease on dual antiplatelet therapy and 10 controls were enrolled. We performed an exercise test using a cycle ergometer and determined the adenosine diphosphate-induced platelet reactivity before and immediately after exercise testing. Additionally, we analysed maximal exercise capacity and an electrocardiogram. Further, we assessed chromogranin A and P-selectin levels and platelet counts.

 
  • References

  • 1 Anfossi G, Trovati M. Role of catecholamines in platelet function: pathophysiological and clinical significance. Eur J Clin Invest 1996; 26: 353-370
  • 2 Bonello L, Tantry US, Marcucci R. et al. Working Group on High On-Treatment Platelet R. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol 2010; 56: 919-933
  • 3 Cadroy Y, Pillard F, Sakariassen KS. et al. Strenuous but not moderate exercise increases the thrombotic tendency in healthy sedentary male volunteers. J Appl Physiol 2002; 93: 829-833
  • 4 Chen S, Du C, Shen M. et al. Sympathetic stimulation facilitates thrombopoiesis by promoting megakaryocyte adhesion, migration, and proplatelet formation. Blood 2016; 127: 1024-1035
  • 5 Cryer PE, Wortsman J, Shah SD. et al. Plasma chromogranin A as a marker of sympathochromaffin activity in humans. Am J Physiol 1991; 260: E243-E246
  • 6 Fletcher GF, Ades PA, Kligfield P. et al. American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology; Council on Nutrition, Physical Activity and Metabolism; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention . Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 2013; 128: 873-934
  • 7 Harriss DJ, Macsween A, Atkinson G. Standards for ethics in sport and exercise science research: 2018 update. Int J Sports Med 2017; 38: 1126-1131
  • 8 Ibanez B, James S, Agewall S. et al. ESC Scientific Document Group . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-177
  • 9 Kim HS, Kim SY, Lee UJ. et al. Terrible stent thrombosis induced by a treadmill test performed three days after percutaneous coronary intervention. Chonnam Med J 2014; 50: 23-26
  • 10 Kratz A, Wood MJ, Siegel AJ. et al. Effects of marathon running on platelet activation markers: direct evidence for in vivo platelet activation. Am J Clin Pathol 2006; 125: 296-300
  • 11 Li N, Wallen NH, Hjemdahl P. Evidence for prothrombotic effects of exercise and limited protection by aspirin. Circulation 1999; 100: 1374-1379
  • 12 Linnemann B, Thalhammer A, Wolf Z. et al. Late peripheral stent thrombosis due to stent fracture, vigorous exercise and hyporesponsiveness to clopidogrel. Vasa 2012; 41: 136-144
  • 13 Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis. Semin Thromb Hemost 2009; 35: 269-276
  • 14 Mittleman MA, Maclure M, Tofler GH. et al. Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion. Determinants of Myocardial Infarction Onset Study Investigators. N Engl J Med 1993; 329: 1677-1683
  • 15 Nickel T, Lackermair K, Scherr J. et al. Influence of high polyphenol beverage on stress-induced platelet activation. J Nutr Health Aging 2016; 20: 586-593
  • 16 Nickel T, Vogeser M, Emslander I. et al. Extreme exercise enhances chromogranin A levels correlating with stress levels but not with cardiac burden. Atherosclerosis 2012; 220: 219-222
  • 17 Perneby C, Wallen NH, Hu H. et al. Prothrombotic responses to exercise are little influenced by clopidogrel treatment. Thromb Res 2004; 114: 235-243
  • 18 Piepoli MF, Hoes AW, Agewall S. et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315-2381
  • 19 Sibbing D, Braun S, Morath T. et al. Platelet reactivity after clopidogrel treatment assessed with point-of-care analysis and early drug-eluting stent thrombosis. J Am Coll Cardiol 2009; 53: 849-856
  • 20 Tantry US, Bonello L, Aradi D. et al. Working Group on On-Treatment Platelet Reactivity . Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol 2013; 62: 2261-2273
  • 21 Thompson PD, Franklin BA, Balady GJ. et al. American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Council on Clinical Cardiology; American College of Sports Medicine . Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition. Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007; 115: 2358-2368
  • 22 Valgimigli M, Bueno H, Byrne RA. et al. ESC Scientific Document Group; ESC Committee for Practice Guidelines (CPG); ESC National Cardiac Societies . 2017; ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2018; 39: 213-260
  • 23 Zwart B, Van Kerkvoorde TC, van Werkum JW. et al. Vigorous exercise as a triggering mechanism for late stent thrombosis: a description of three cases. Platelets 2010; 21: 72-76