THROMBOSIS RESEARCH 84; 487-491,1991 004%3848/91 $3.00 + .OO Printed in the USA. Copyright (c) 1991 Pergamon Press pk. All rights reserved.
CIRCADIAN VARIATIONS OF PLATELET AGGREGABILITY AND FIBRINOLYTIC ACTIVITY IN PATIENTS WITH ISCHEMIC STROKE 1 2 1 JoviEid A.,211vanigevic V., Nikolajevic R., Clinic of Clinical chemical laboratory, Military Medical Neurology, Academy, Belgrade, Yugoslavia
(Received 19.8.1991; accepted in revised form 8.9.1991 by Editor H.A. Vinazzer)
ABSTRACT The purpose of this study was to determine circadian dynamics of platelet aggregability and fibrinolytic activity in patients with ischemic stroke. The study was carried out in 21 male patients, aged from 51 to 65 years in acute phase of severe hemispheric brain infarction diagnosed clinically and radiologically. The examinations showed that circadian variations of platelet aggregability and fibrinolytic activity were persistent, but the intervals and the degree of oscillation differed from those in healthy persons. The significance was discussed.
of these disorders for clinical purposes
INTRODUCTION Oscillation in activity of some biological systems in one of the basic principles of functioning both of an organism and of its subsystems. The results of our earlier investigations have shown significant variations of platelet aggregability (PA) and fibrinolyticactivity in healthy persons (1). The circadian variations in frequency of ischemic stroke and myocardial infarction were also assessed (2,3,4,5). However, the levels of some hemostatic parameters during the 24-hour time have been very rarely investigated (6). Key words: Circadian variation, Platelet aggregability, Fibrinolytic activity, Ischemic stroke. 487
488
CIRCADIAN
VARIATIONS...
Vol. 64, No. 4
The aim of this study was to determine the dynamics of PA and fibrinolytic activity in certain periods of a day in patients with ischemic stroke.
PATIENTS AND METHODS The study included 21 male patients, aged from 51 to 65 years who had brain infarction. The diagnosis of brain infarction was based on clinical and radiological findings, and the ultrasound examinations of the carotid artery. The diagnosis of brain infarction was estabilished in patients with history suggesting ischemic stroke, with neurologic deficit persisting for more than 24 hours, with the finding of computerised brain tomography which was consistent with recent hemispheric.cortical infarction in areas supplied by large cerebral arteries and ultrasound evidence of existing carotid disease on the relevant side. The patients included into this study exhibited severe clinical deficit according to the following criteria (7): the patients with hemiplegia or global aphasia who could not be assisted towards walking or talking, yet whose consciousness was not quantitatively disturbed and with whom there had not elapsed more than 72 hours since the onset of ischemic stroke. The study excluded the patients with diabetes, history and actual clinical finding of ischemic heart disease, arterial hypertension, atria1 fibrillation and left ventricle hypertrophy. The same therapy was applied in all patients both concerning the types of drugs and their doses (xanthine products in solution of 10% hypertonic mannitol i.v. and E vitamin orally). Blood samples, obtained by venepuncture, were collected from all the patients at the following intervals: 07.00, 11.00, 13.00,15.00, 18.00, 24.00. The blood samples were taken within 7 days after ictus by the same medical technician and the planned analyses were always made by same biochemist. The methods of analysis of some hemostatic parameters: (PA), euglobulin lysis time (ELT), fibrinogen degradation products (FDP), heparin tolerance test (HTT), and antithrombin III (AT III) were described in detail in our earlier study (1). The results were statistically processed: mean values, standard deviation and significant differences. The statistical evaluation of term-to-term differences was performed by Student's t-test. The significance level was Set St 0.005.
RESULTS Table 1 presents mean values and standard deviations (SD) of the parameters studied at 07.00, 11.00, 13.00, 15.00, 18.00 and 24.00. It can be observed that a significant variation for found only at midnight with respect to the previous FDP fluctuates significantly at 18.00 and 24.00h. The degree of prominence of PA, AT and FDP at other not exhibit appreciable variations. Heparin activity variation to that of FDP. Antithrombin activity did significant variations during the 24-hour cycle.
PA and ELT was analysis time. intervals does showed similar not exhibit
Vol. 64, No. 4
TABLE
*
CIRCADIAN VARIATIONS...
489
1
Circadian variation of PA, EL:, FDP, HTT and AT III All values are shown as mean - standard deviation. Statistically significant difference to previous term ( P
CIRCADIAN VARIATIONS OF PLATELET AGGREGABILITY AND FIBRINOLYTIC ACTIVITY IN PATIENTS WITH ISCHEMIC STROKE 1 2 1 JoviEid A.,211vanigevic V., Nikolajevic R., Clinic of Clinical chemical laboratory, Military Medical Neurology, Academy, Belgrade, Yugoslavia
(Received 19.8.1991; accepted in revised form 8.9.1991 by Editor H.A. Vinazzer)
ABSTRACT The purpose of this study was to determine circadian dynamics of platelet aggregability and fibrinolytic activity in patients with ischemic stroke. The study was carried out in 21 male patients, aged from 51 to 65 years in acute phase of severe hemispheric brain infarction diagnosed clinically and radiologically. The examinations showed that circadian variations of platelet aggregability and fibrinolytic activity were persistent, but the intervals and the degree of oscillation differed from those in healthy persons. The significance was discussed.
of these disorders for clinical purposes
INTRODUCTION Oscillation in activity of some biological systems in one of the basic principles of functioning both of an organism and of its subsystems. The results of our earlier investigations have shown significant variations of platelet aggregability (PA) and fibrinolyticactivity in healthy persons (1). The circadian variations in frequency of ischemic stroke and myocardial infarction were also assessed (2,3,4,5). However, the levels of some hemostatic parameters during the 24-hour time have been very rarely investigated (6). Key words: Circadian variation, Platelet aggregability, Fibrinolytic activity, Ischemic stroke. 487
488
CIRCADIAN
VARIATIONS...
Vol. 64, No. 4
The aim of this study was to determine the dynamics of PA and fibrinolytic activity in certain periods of a day in patients with ischemic stroke.
PATIENTS AND METHODS The study included 21 male patients, aged from 51 to 65 years who had brain infarction. The diagnosis of brain infarction was based on clinical and radiological findings, and the ultrasound examinations of the carotid artery. The diagnosis of brain infarction was estabilished in patients with history suggesting ischemic stroke, with neurologic deficit persisting for more than 24 hours, with the finding of computerised brain tomography which was consistent with recent hemispheric.cortical infarction in areas supplied by large cerebral arteries and ultrasound evidence of existing carotid disease on the relevant side. The patients included into this study exhibited severe clinical deficit according to the following criteria (7): the patients with hemiplegia or global aphasia who could not be assisted towards walking or talking, yet whose consciousness was not quantitatively disturbed and with whom there had not elapsed more than 72 hours since the onset of ischemic stroke. The study excluded the patients with diabetes, history and actual clinical finding of ischemic heart disease, arterial hypertension, atria1 fibrillation and left ventricle hypertrophy. The same therapy was applied in all patients both concerning the types of drugs and their doses (xanthine products in solution of 10% hypertonic mannitol i.v. and E vitamin orally). Blood samples, obtained by venepuncture, were collected from all the patients at the following intervals: 07.00, 11.00, 13.00,15.00, 18.00, 24.00. The blood samples were taken within 7 days after ictus by the same medical technician and the planned analyses were always made by same biochemist. The methods of analysis of some hemostatic parameters: (PA), euglobulin lysis time (ELT), fibrinogen degradation products (FDP), heparin tolerance test (HTT), and antithrombin III (AT III) were described in detail in our earlier study (1). The results were statistically processed: mean values, standard deviation and significant differences. The statistical evaluation of term-to-term differences was performed by Student's t-test. The significance level was Set St 0.005.
RESULTS Table 1 presents mean values and standard deviations (SD) of the parameters studied at 07.00, 11.00, 13.00, 15.00, 18.00 and 24.00. It can be observed that a significant variation for found only at midnight with respect to the previous FDP fluctuates significantly at 18.00 and 24.00h. The degree of prominence of PA, AT and FDP at other not exhibit appreciable variations. Heparin activity variation to that of FDP. Antithrombin activity did significant variations during the 24-hour cycle.
PA and ELT was analysis time. intervals does showed similar not exhibit
Vol. 64, No. 4
TABLE
*
CIRCADIAN VARIATIONS...
489
1
Circadian variation of PA, EL:, FDP, HTT and AT III All values are shown as mean - standard deviation. Statistically significant difference to previous term ( P
