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The Role of Exercise on Platelet Aggregation in Patients with Stable Coronary Artery Disease: Exercise Induces Aspirin Resistant Platelet Activation

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Abstract

Objectives: The aim of our study was to determine the relation between exercise stress test and aspirin resistance in patients with stable coronary artery disease.

Background: Clinically aspirin resistance is defined as having thrombotic and embolic cardiovascular events despite regular aspirin therapy.

Methods: We studied platelet functions of 62 patients with stable coronary artery disease and 20 subjects with normal coronary arteries by Platelet Function Analyzer (PFA-100, Dade Behring, Germany) at rest and after exertion with collagen and/or epinephrine (Col/Epi) and collagen and/or ADP cartridges. Closure time (CT) < 186 seconds was defined as aspirin resistance with Col/Epi cartridges of PFA-100. Symptom limited treadmill stress test (protocol of Bruce) was performed with Oxford Streslink TD-1 system.

Results: 8 (12.9%) patients were aspirin resistant by PFA-100 (CT < 186s despite regular aspirin therapy) at rest. At the first minute of the recovery period of exercise stress test 14 (22.5%) patients were aspirin resistant by PFA-100. CTs with Col/ADP were respectively 89 ± 6 s (83–100s) and 89 ± 5 s (82–104s) at rest and after exercise (p = 0.107). 20.3% (11/54) of patients known as in vitro aspirin sensitives at rest had shorter CTs and 11.1% (6/54) had aspirin resistance after exercise (p = 0.004). There was no statistically significiant difference in platelet functions in the control group after exertion.

Conclusion: We conclude that 11.1% of in vitro aspirin sensitive subjects at rest had aspirin resistance after exercise by PFA-100. In some individuals, exercise induced platelet activation is aspirin insensitive at usual antiplatelet doses. We need further clinical trials to optimize antiplatelet therapy in patients with coronary artery disease.

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Authors and Affiliations

  1. Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Burak Pamukcu (MD), Huseyin Oflaz, Rezzan Deniz Acar, Sabahattin Umman, Nevres Koylan, Berrin Umman & Yilmaz Nisanci

  2. Istanbul Tip Fakultesi Kardiyoloji Anabilim Dali, Istanbul Universitesi, Capa, Istanbul, Turkey

    Burak Pamukcu (MD)

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  1. Burak Pamukcu
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  2. Huseyin Oflaz
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  3. Rezzan Deniz Acar
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  4. Sabahattin Umman
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  5. Nevres Koylan
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  6. Berrin Umman
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  7. Yilmaz Nisanci
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Correspondence to Burak Pamukcu.

Additional information

The main supporter of the study was Turkish Society of Cardiology (Istanbul, Turkey). The society is a non-profit association and a member of the European Society of Cardiology. The PFA-100 device and test cartridges are bought with the grant of this non-profit association.

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Pamukcu, B., Oflaz, H., Acar, R.D. et al. The Role of Exercise on Platelet Aggregation in Patients with Stable Coronary Artery Disease: Exercise Induces Aspirin Resistant Platelet Activation. J Thromb Thrombolysis 20, 17–22 (2005). https://doi.org/10.1007/s11239-005-2318-1

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  • DOI: https://doi.org/10.1007/s11239-005-2318-1

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