Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark.
Centre for Immunobiology, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Acta Physiol (Oxf). 2018 May;223(1):e13028. doi: 10.1111/apha.13028. Epub 2018 Jan 19.
The current guidelines following an acute coronary syndrome recommend dual-antiplatelet therapy (DAPT) (aspirin plus a P2Y antagonist) alongside lifestyle modifications, including more regular physical activity. It is currently unknown whether regular exercise affects the pharmacology of DAPT.
To explore how exercise-induced improvements in vascular and platelet function affect the efficacy of DAPT, in a cross-sectional study of men with different physical activity levels (training status).
A total of 42 healthy, normal-weight, middle-aged men were divided into 3 groups: untrained, moderately trained and well-trained. Their platelet reactivity (agonist-induced % aggregation) was investigated in platelet-rich plasma at rest and after inhibition with aspirin and ticagrelor and/or prostacyclin and nitric oxide added to the blood in vitro, and after physiological tests of vascular function; passive movement of the leg, flow-mediated dilation and one-leg knee-extensor exercise. Vascular function of the femoral artery (changes in arterial blood flow) was assessed by ultrasound Doppler.
Platelets from the well-trained subjects had lower basal reactivity, a higher sensitivity to the anti-aggregatory effects of prostacyclin and were more potently inhibited by DAPT compared to the untrained subjects. The moderately trained and well-trained subjects had a superior vascular function compared to untrained subjects, and their platelets were more inhibited by the passive movement, flow-mediated dilation and one-leg knee-extensor exercise.
A habitually active lifestyle leads to an increased platelet sensitivity to pharmacological and physiological platelet inhibitors. We suggest that physical activity habits (training status) should be considered when personalizing and optimizing antithrombotic treatment strategies.
在不同身体活动水平（训练状态）的男性中进行一项横断面研究，探讨运动引起的血管和血小板功能改善如何影响 DAPT 的疗效。
共纳入 42 名健康、体重正常、中年男性，分为 3 组：未训练组、适度训练组和良好训练组。在血小板富血浆中检测血小板反应性（激动剂诱导的%聚集），并在体外加入阿司匹林和替格瑞洛以及/或前列环素和一氧化氮抑制后，以及在血管功能的生理测试后（腿部被动运动、血流介导的扩张和单腿伸膝运动）进行检测；采用超声多普勒评估股动脉的血管功能（动脉血流变化）。
与未训练组相比，良好训练组的基础反应性较低，对前列环素的抗聚集作用更敏感，且对 DAPT 的抑制作用更强。与未训练组相比，中度训练组和良好训练组的血管功能更好，其血小板在被动运动、血流介导的扩张和单腿伸膝运动中受到更强的抑制。
习惯性的活跃生活方式导致血小板对药理学和生理血小板抑制剂的敏感性增加。我们建议在个体化和优化抗血栓治疗策略时应考虑身体活动习惯（训练状态）。
