title: Pro-coagulant activity during exercise testing in patients with coronary artery disease.
abstract: BACKGROUND
  Strenuous exercise may trigger myocardial infarction through increased pro-coagulant activity. We aimed to investigate whether patients referred for exercise testing, who were found to have angiographically verified coronary artery disease (CAD), have a more hypercoagulable profile during exercise testing than those without CAD.
  
  
  METHODS
  Patients with symptoms of stable CAD were examined with exercise electrocardiography on bicycle ergometer. Venous blood samples were taken at rest and within 5 min after end of exercise. The following haemostatic variables were analyzed: tissue factor pathway inhibitor (TFPI) activity and antigen, prothrombin fragment 1 + 2 (F1 + 2), D-dimer and endogenous thrombin potential (ETP). All participants underwent conventional coronary angiography. CAD was defined as having any degree of atherosclerosis.
  
  
  RESULTS
  Out of the 106 patients enrolled, 70 were found to have CAD. Mean exercise duration was 10:06 ± 4:11 min, with no significant differences between the groups. A significant increase from baseline to after exercise testing was observed in all measured markers in the total population (p≤ 0.002 for all). In patients with angiographically verified CAD, total TFPI was significantly lower at baseline compared to patients without CAD (median value 67.4 and 76.6 ng/ml respectively,p= 0.027). However, no significant differences in changes of any of the measured markers during exercise were observed between the two groups.
  
  
  CONCLUSIONS
  Pro-coagulant activity increased during short-term strenuous exercise testing in patients with symptoms suggestive of CAD. However the hypercoagulable state observed, was not more pronounced in patients with angiographically verified CAD compared to patients without CAD. NCT01495091.
authors.affiliation: Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.|Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway.
authors.forename: Joanna
authors.identifier: 0000-0003-2258-1320
authors.initials: J
authors.lastname: Cwikiel
authors.affiliation: Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.|Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Ingebjorg
authors.initials: I
authors.lastname: Seljeflot
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.
authors.forename: Eivind
authors.initials: E
authors.lastname: Berge
authors.affiliation: Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevaal, PB 4956 Nydalen, 0424 Oslo, Norway.|Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
authors.affiliation: Department of Cardiology, Division of Cardiovascular and Pulmonary diseases, Oslo University Hospital, Oslo, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Wachtell
authors.affiliation: Modum Bad, Vikersund, Norway.
authors.forename: Hilde
authors.initials: H
authors.lastname: Ulsaker
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.|Section of Cardiovascular and Renal research, Oslo University Hospital Ulleval, Oslo, Norway.
authors.forename: Arnljot
authors.initials: A
authors.lastname: Flaa
keywords: Angina; Atherosclerosis; Coagulation; Coronary angiography; Exercise testing