Document Detail


Practical implications of circadian variations in thrombolytic and antithrombotic activities.
MedLine Citation:
PMID:  8724557     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
It recently has been demonstrated that thrombolytic therapy has circadian pattern of efficacy, as assessed by the ability to rapidly provide coronary patency. A study of 692 patients receiving intravenous tPA and undergoing acute coronary arteriography demonstrated a substantial diurnal pattern in patency with a peak at 8:00 pm. The heightened tendency for a coronary artery to be opened in the evening correlates well with the substantial tendency demonstrated in the same study and in multiple other studies for coronary arteries to thrombose and cause myocardial infarction in the morning hours. Circadian variations have been defined for a number of hemostatic and physiologic factors that would predispose toward clotting in the late morning, and converse circadian patterns have been described for a number of factors associated with thrombolysis that would predispose towards enhanced fibrinolysis in the evening hours. Methods by which efficacy of lytic therapy potentially could be enhanced include development of tPA variants or adjunctive agents that eliminate the circadian nadirs of efficacy, modification of dosage or choice of lytic agent as a function of time of treatment, and selection between pharmacologic lysis and direct angioplasty as a function of time of day.
Authors:
P B Kurnik
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Cardiology clinics     Volume:  14     ISSN:  0733-8651     ISO Abbreviation:  Cardiol Clin     Publication Date:  1996 May 
Date Detail:
Created Date:  1996-10-17     Completed Date:  1996-10-17     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  8300331     Medline TA:  Cardiol Clin     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  251-62     Citation Subset:  IM    
Affiliation:
Department of Medicine, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Camden, USA.
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MeSH Terms
Descriptor/Qualifier:
Blood Coagulation
Circadian Rhythm*
Humans
Myocardial Infarction / drug therapy
Plasminogen Activator Inhibitor 1 / therapeutic use
Plasminogen Activators / therapeutic use
Thrombolytic Therapy*
Time Factors
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Vascular Patency
Chemical
Reg. No./Substance:
0/Plasminogen Activator Inhibitor 1; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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