Asymptomatic patients with carotid atherosclerosis present a higher coagulation state compared to healthy subjects

Background In pro-inflammatory conditions, such as atherosclerosis, circulating monocytes may express tissue factor (TF), increasing thromboembolic risk. Regular physical activity (PA) has been shown to modulate hemostasis by reducing fibrinogen concentration and platelet activation, though its effects on coagulation are limited. Objectives We aim to evaluate the procoagulant and proinflammatory state in asymptomatic patients with atherosclerotic carotids compared to healthy subjects and to assess the impact of a 6-month PA intervention. Methods This study included patients with asymptomatic carotid stenosis and healthy subjects. Patients were randomized into a PA group (6-month individualized PA intervention), and a control group. Blood analyses were performed to assess monocyte phenotype and TF expression by flow cytometry, and coagulation parameters using rotative thromboelastometry. Results The expression of TF on the surface of circulating monocytes was significantly higher in patients than in healthy subjects (61.9 ± 11.7 % vs 33.7 ± 6.3 %, p<0.0001), mainly explained by a higher expression on classical monocytes (77.7 ± 9.5 vs 58.3 ± 15.8 %, p<0.001). Clotting times were lower in patients than in healthy subjects in basal (407.8 77.7 ± 144.6 sec vs 615.5 ± 123.4 sec p<0.0001) and proinflammatory (222.4 ± 48.2 sec vs 307.8± 82.4 sec p=0.003) conditions. A 6-month PA intervention did not induce any modulation of the monocyte phenotype or coagulation parameters of patients with atherosclerosis. Conclusion Asymptomatic patients with carotid atherosclerosis have a higher proinflammatory and procoagulant profile, suggesting a higher thromboembolic risk. However, home-based PA intervention did not improve their profiles.