Document Detail


The effect of supervised exercise and cilostazol on coagulation and fibrinolysis in intermittent claudication: a randomized controlled trial.
MedLine Citation:
PMID:  17210383     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The prothrombotic, hypofibrinolytic state that develops in patients with intermittent claudication (IC) upon walking due to ischemia-reperfusion injury (IRI) of the leg muscles may contribute to the high incidence of life- and limb-threatening thrombotic events observed in this patient group. Treatments, such as angioplasty, that obtund the IRI also ameliorate the procoagulant diathesis. The effect on this diathesis of supervised exercise and cilostazol, both of which provide symptomatic benefit in IC, but without significantly obtunding IRI, is unknown.
METHODS: Thirty-four patients (27 men and 7 women; median age, 67 years; range, 63-72 years) were randomized to receive best medical therapy (BMT) plus supervised exercise (n = 9), BMT plus cilostazol (n = 9), BMT plus supervised exercise plus cilostazol (n = 7), or BMT alone (n = 9) in a 2 x 2 factorial design. Thrombin-antithrombin complex and prothrombin fragments 1 and 2, both markers of thrombin generation; plasminogen activator inhibitor antigen and tissue plasminogen activator antigen, both markers of fibrinolysis; ankle-brachial pressure index (ABPI); and initial and absolute claudication distance (ACD) were measured at baseline and then 3 and 6 months after randomization.
RESULTS: At 6 months, when compared with receiving BMT only, supervised exercise and cilostazol resulted in improvements in ABPI of 18% and 13% and in ACD of 40% and 64%, respectively. The effects on ABPI and ACD of combining supervised exercise and cilostazol were additive. Supervised exercise, cilostazol, and supervised exercise combined with cilostazol had no significant effect on any of the four hemostatic markers.
CONCLUSIONS: Treatment of IC by supervised exercise or cilostazol results in significant improvements in ABPI and ACD but has no demonstrable effect on the prothrombotic diathesis. This suggests that supervised exercise and cilostazol, unlike angioplasty, are unlikely to have a long-term beneficial effect on the thrombotic risks faced by these patients.
Authors:
Simon D Hobbs; Tim Marshall; Chris Fegan; Donald J Adam; Andrew W Bradbury
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  45     ISSN:  0741-5214     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2007 Jan 
Date Detail:
Created Date:  2007-01-09     Completed Date:  2007-02-08     Revised Date:  2013-05-30    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  65-70; discussion 70     Citation Subset:  IM    
Affiliation:
University Department of Vascular Surgery, Heart of England NHS Foundation Trust, Birmingham, UK. simon@hobbsy.fsworld.co.uk
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MeSH Terms
Descriptor/Qualifier:
Aged
Antithrombin III / drug effects
Biological Markers / blood
Enzyme-Linked Immunosorbent Assay
Exercise Therapy / methods*
Female
Fibrinolysis / drug effects,  physiology*
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Humans
Intermittent Claudication / blood*,  physiopathology,  therapy*
Male
Middle Aged
Peptide Fragments / blood,  drug effects
Peptide Hydrolases / blood,  drug effects
Protein Precursors / blood,  drug effects
Prothrombin / drug effects
Tetrazoles / therapeutic use*
Treatment Outcome
Walking / physiology
Chemical
Reg. No./Substance:
0/Biological Markers; 0/Fibrinolytic Agents; 0/Peptide Fragments; 0/Protein Precursors; 0/Tetrazoles; 0/antithrombin III-protease complex; 72270-84-9/prothrombin fragment 1; 78768-79-3/prothrombin fragment 2; 9000-94-6/Antithrombin III; 9001-26-7/Prothrombin; EC 3.4.-/Peptide Hydrolases; N7Z035406B/cilostazol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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