Influence of changes in lifestyle on fibrinolytic parameters and recurrence rate in patients with venous thromboembolism.
A prospective, non-randomized, interventional study was carried out to evaluate the effect of changes in lifestyle on abnormal fibrinolytic parameters, and the influence of those, in turn, on the risk of recurrence among patients with venous thromboembolism. Patients with elevated plasminogen activator inhibitor 1 (PAI-1) levels or decreased release of tissue plasminogen activator (t-PA) antigen were given information and advice about improved diet, increased physical activity, weight loss and/or cessation of smoking. Totally 144 patients (119 with elevated PAI-1 and 25 with deficient t-PA release) were followed with repeated analyses of the fibrinolytic parameters for a median of 8 months after the initial advice, and 65% of the patients managed to execute at least one change in their lifestyle. The reduction of PAI-1 activity after one, two and three changes in lifestyle were -2.4, -10.0 and -14.0 AU/ml (-10, -30 and -48% of baseline activity), respectively. Those who accomplished two or three changes in their lifestyle had a greater chance of normalizing the PAI-1 level than those with no or only one change (P = 0.009). The effects of improved diet, weight loss and increased physical activity on the PAI-1 level were of a similar magnitude, -7.0 to -10.4 AU/ml (24-32% reduction). The effect on t-PA release was more difficult to evaluate due to the limited number of those patients. After a follow-up of 6 years (mean) after the first visit the patients were inquired about recurrent events, with a response rate of 86%.(ABSTRACT TRUNCATED AT 250 WORDS)
Schulman, S; Lindmarker, P; Johnsson, H
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