Document Detail

Circadian fluctuations in the efficacy of thrombolysis with streptokinase.
MedLine Citation:
PMID:  10621877     Owner:  NLM     Status:  MEDLINE    
This study was designed to investigate possible diurnal fluctuations in the efficacy of thrombolysis with streptokinase and whether they follow the circadian periodicity which has already been well documented for the time of onset of acute myocardial infarction, transient myocardial ischaemia, sudden cardiac death, thrombotic stroke, and for the efficacy of thrombolysis with tissue-type plasminogen and urokinase. A total of 156 consecutive patients treated with streptokinase were studied retrospectively; success or failure of thrombolysis was determined according to accepted clinical and angiographic criteria. A definite time peak for successful thrombolysis could be detected at the late afternoon and early evening hours; between 16.00 and 20.00 h, 30.2% of all successful thrombolysis cases were observed compared with 7.0% between 20.00 and 24.00 (p < 0.05) or 10.5% between 00.00 and 04.00 (p < 0.05). Between 16.00 and 20.00 h, 75.8% of treated patients had successful thrombolysis compared to 15.2% of failed treatments and 9% equivocal results (p < 0.001). Multiple regression analysis showed that the independent factor with the major impact on successful reperfusion was the actual time of thrombolysis (p = 0.037), followed by the time delay from pain onset to streptokinase administration (p = 0.020), while age and gender had much lesser impact (p = 0.328 and 0.215, respectively) and the individual risk factors even less. These findings may have several clinical implications; dose adjustment for the time of day may be required, with higher doses during morning hours, or preference for primary coronary angioplasty in order to avoid the increase in bleeding complications related to higher doses of thrombolytic agents.
E Goldhammer; L Kharash; E G Abinader
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Postgraduate medical journal     Volume:  75     ISSN:  0032-5473     ISO Abbreviation:  Postgrad Med J     Publication Date:  1999 Nov 
Date Detail:
Created Date:  2000-01-21     Completed Date:  2000-01-21     Revised Date:  2009-10-22    
Medline Journal Info:
Nlm Unique ID:  0234135     Medline TA:  Postgrad Med J     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  667-71     Citation Subset:  IM    
Department of Cardiology, Bnei-Zion Medical Center, Haifa, Israel.
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MeSH Terms
Aged, 80 and over
Aspirin / therapeutic use
Chi-Square Distribution
Circadian Rhythm*
Drug Administration Schedule
Middle Aged
Myocardial Infarction / drug therapy*
Platelet Aggregation Inhibitors / therapeutic use
Regression Analysis
Streptokinase / therapeutic use*
Thrombolytic Therapy*
Time Factors
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; EC 3.4.-/Streptokinase

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