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Both atenolol and propranolol blunt the fibrinolytic response to exercise but not resting fibrinolytic potential

      Low fibrinolytic activity and high levels of coagulation markers are related to the incidence of ischemic cardiovascular disease, reinfarction, and thromboembolic events.
      • Meade T.W.
      • Ruddock V.
      • Stirling Y.
      • Chakrabarti R.
      • Miller G.J.
      Fibrinolytic activity, clotting factors, and long term incidence of ischaemic heart disease in the Northwick Park Heart Study.
      ,
      • Hamsten A.
      • DeFaire U.
      • Walldius G.
      • Dahlen G.
      • Szamosi A.
      • Landou C.
      • Blomback M.
      • Wiman B.
      Plasminogen activator inhibitor in plasma risk factor for recurrent myocardial infarction.
      ,
      • Kienast J.
      • Thompson S.G.
      • Raskino C.
      • Pelzer H.
      • Fechtrup C.
      • Ostermann H.
      • van de Loo J.
      Prothrombin activation fragment 1+2 and thrombin antithrombin III complexes in patients with angina pectoris relation to the presence and severity of coronary atherosclerosis.
      Acute physical exercise is a potent stimulator of fibrinolysis and coagulation.
      • Fernhall B.
      • Szymanski L.M.
      • Gorman P.A.
      • Milani J.
      • Paup D.C.
      • Kessler C.M.
      Fibrinolytic activity is similar in physically active men with and without a history of myocardial infarction.
      ,
      • Fernhall B.
      • Szymanski L.M.
      • Gorman P.A.
      • Milani J.
      • Paup D.C.
      • Kessler C.M.
      Fibrinolytic activity is not dependent upon exercise mode in post-myocardial infarction patients.
      ,
      • Szymanski L.M.
      • Pate R.R.
      • Durstine J.L.
      Effects of maximal exercise and venous occlusion on fibrinolytic activity in physically active and inactive men.
      ,
      • Szymanski L.M.
      • Pate R.R.
      Fibrinolytic responses to moderate intensity exercise comparison of physically active and inactive men.
      The ability to increase fibrinolytic activity and maintain hemostatic balance in response to maximal exercise is often used to detect abnormalities that are not necessarily evident at rest
      • Szymanski L.M.
      • Pate R.R.
      • Durstine J.L.
      Effects of maximal exercise and venous occlusion on fibrinolytic activity in physically active and inactive men.
      and may be predictive of future cardiovascular events.
      • Held C.
      • Hjemdahl P.
      • Rehnqvist N.
      • Wallen H.
      • Bjorklander I.
      • Eriksson S.V.
      • Forslund L.
      • Wiman B.
      Fibrinolytic variables and cardiovascular prognosis in patients with stable angina pectoris treated with verapamil or metropolol.
      Beta blockers prevent reinfarction and are effective for treatment of hypertension and angina.
      Beta-blocker Heart Attack Trial Research Group
      A randomized trial of propanolol in patients with acute myocardial infarction.
      Their influence on hemostasis is unclear and timolol has been related to an increased occurrence of left ventricular thrombi in patients with acute myocardial infarction.
      • Johannessen K.A.
      • Nordrehaug J.E.
      • von der Lippe G.
      Increased occurrence of left ventricular thrombi during early treatment with timolol in patients with acute myocardial infarction.
      Only a few studies have evaluated the effect of β blockade on fibrinolysis during exercise,
      • El-Sayed M.S.
      Extrinsic plasminogen activator response to exercise after a single dose of propanolol.
      and have shown inconsistent results. During exercise, no studies have evaluated the effect of selective and nonselective β blockade on fibrinolytic activity, with simultaneous measurements of in vivo markers of coagulation activation. Measures of fibrinolysis and coagulation activation are needed to obtain a more complete picture of hemostatic balance. The purpose of this study was to evaluate the effect of propranolol and atenolol on fibrinolytic markers and coagulation activation at rest and after maximal exercise using a randomized, double-blind crossover design.
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