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Title: Haemostatic changes in intermittent claudication
Author: Burns, Paul
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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Introduction. Intermittent claudication (IC) is the commonest manifestation of atherosclerosis affecting the lower limbs. As IC is known to be accompanied by a well characterised systemic response – probably secondary to the repeated ischaemia-reperfusion seen during exercise in claudicants, this could putatively affect the coagulation system, leading to the increased risk of cardiovascular thrombotic events which these patients suffer from. We aimed therefore, to study the effect of exercise on the coagulation system in patients with IC. Methods. Forty subjects were studied, 20 claudicants, and 20 age and sex-matched controls. Coagulation parameters before and after standard treadmill exercise in order to measure thrombin generation, thrombin turnover, and fibrinolysis. Results. Thrombin production in claudicants was significantly higher following exercise than non-claudicants. This was not accompanied by an corresponding increase in fibrinolysis when compared to the controls, resulting in a probable prothrombotic state. There was increased fibrin turnover in the claudicants at baseline, but no appreciable effect of exercise. The claudicants who could walk further seemed to have a better fibrinolytic response than the claudicants with poorer walking distances. Platelet activation following exercise was less in the claudicants than in the controls – probably reflecting the increased use of aspirin in these subjects. All groups have an increase in neutrophil activation following exercise, but this was more in the controls groups. This may reflect sequestration of neutrophils in the peripheral or pulmonary) circulation in the claudicants. Conclusion. Exercise in claudicants can lead to a prothrombotic state, characterised by increased thrombin generation. This needs to be further evaluated to determine whether this has clinical consequences, and can be ameliorated with treatment.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available