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(Circulation. 1974;50:887.)
© 1974 American Heart Association, Inc.

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Reversal of Abnormal Platelet Aggregability and Change in Exercise Tolerance in Patients with Angina Pectoris Following Oral Propranolol

WILLIAM H. FRISHMAN M.D.¹; BABETTE WEKSLER M.D.¹; JAMES P. CHRISTODOULOU M.D.¹; CHARLES SMITHEN M.D.¹; THOMAS KILLIP M.D.¹

¹ From the Divisions of Cardiology and Hematology, Department of Medicine, The New York Hospital-Cornell Medical Center, New York, New York.

Nineteen patients with severe but stable angina pectoris who had positive ECG response to exercise on a bicycle ergometer and 11 normal subjects were studied. Patients received placebo for six weeks and were then randomized into placebo (n = 9) and propranolol (n = 10) treatment groups. Threshold for platelet aggregation in response to adenosine diphosphate (ADP) was measured in fresh platelet rich plasma.

Mean concentration of ADP necessary for a biphasic threshold aggregation response was 1.56 µM (geometric mean) in patients and 3.85 µM in normals (P < 0.01). Serial studies with placebo showed no significant change in ADP threshold. With propranolol, 80 mg/day, platelet aggregation in response to ADP was entirely normalized; 3.79 µM ADP produced maximal aggregation compared to 1.32 µM before therapy (P < 0.01). No additional changes were noted with propranolol, 160 mg/day. In the propranolol-treated patients (80 mg/day) who demonstrated reduction in ADP-induced platelet aggregation, total work during exercise increased by 128%, from 765 ± 125 (standard error of mean) kpm during the control period to 1,- 792 ± 285 kpm (P < 0.01).

Thus patients with angina and abnormal exercise tolerance demonstrate increased platelet aggregability in vitro which is restored toward normal with propranolol in dosage sufficient to improve exercise tolerance.

Key Words: Beta-adrenergic blockade • Coronary artery disease • Arteriosclerosis • Exercise tolerance • Thrombosis

Submitted on February 27, 1974
Accepted on June 21, 1974

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