Morning Hypercoagulability and Hypofibrinolysis

Kapiotis, Stylianos; Jilma, Bernd; Quehenberger, Peter; Ruzicka, Katharina; Handler, Sylvia; Speiser, Wolfgang

doi:10.1161/01.cir.96.1.19

Cited by 125 publications

(62 citation statements)

References 23 publications

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“…Prior investigators have demonstrated a surge in sympathetic activity accompanied by vagal withdrawal in the morning hours, leading to an increase in sheer forces secondary to elevation in blood pressure, heart rate, and the rate of pressure change (dP/dt). 22 Similarly, the equilibrium between thrombotic and thrombolytic factors changes in the early morning hours, leading to an increase in hypercoagulability (increased platelet aggregability and greater fibrinogen levels and factor VII activity) 23,24 and hypofibrinolysis (lower fibrinolytic activity). 24 This increases the viscosity of the blood, 25 which may, in turn, further contribute to the increased arterial sheer forces in the morning caused by a heightened sympathetic tone.…”

Section: Discussionmentioning

confidence: 99%

“…22 Similarly, the equilibrium between thrombotic and thrombolytic factors changes in the early morning hours, leading to an increase in hypercoagulability (increased platelet aggregability and greater fibrinogen levels and factor VII activity) 23,24 and hypofibrinolysis (lower fibrinolytic activity). 24 This increases the viscosity of the blood, 25 which may, in turn, further contribute to the increased arterial sheer forces in the morning caused by a heightened sympathetic tone. Such forces presumably act on the aortic wall, which is inherently weakened by genetic and acquired disorders, causing triggering of AAD during the early morning hours.…”

Section: Discussionmentioning

confidence: 99%

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Chronobiological Patterns of Acute Aortic Dissection

et al. 2002

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Background— Chronobiological rhythms have been shown to influence the occurrence of a variety of cardiovascular disorders. However, the effects of the time of the day, the day of the week, or monthly/seasonal changes on acute aortic dissection (AAD) have not been well studied. Methods and Results— Accordingly, we evaluated 957 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2000 (mean age 62±14 years, type A 61%). A χ 2 test for goodness of fit and partial Fourier analysis were used to evaluate nonuniformity and rhythmicity of AAD during circadian, weekly, and monthly periods. A significantly higher frequency of AAD occurred from 6:00 am to 12:00 noon compared with other time periods (12:00 noon to 6:00 pm , 6:00 pm to 12:00 midnight, and 12:00 midnight to 6:00 am ; P <0.001 by χ 2 test). Fourier analysis showed a highly significant circadian variation ( P <0.001) with a peak between 8:00 am and 9:00 am . Although no significant variation was found for the day of the week, the frequency of AAD was significantly higher during winter ( P =0.008 versus other seasons by χ 2 test). Fourier analysis confirmed this monthly variation with a peak in January ( P <0.001). Subgroup analysis identified a significant association for all subgroups with circadian rhythmicity. However, seasonal/monthly variations were observed only among patients aged <70 years, those with type B AAD, and those without hypertension or diabetes. Conclusions— Similar to other cardiovascular conditions, AAD exhibits significant circadian and seasonal/monthly variations. Our findings may have important implications for the prevention of AAD by tailoring treatment strategies to ensure maximal benefits during the vulnerable periods.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronobiological Patterns of Acute Aortic Dissection

et al. 2002

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“…[8][9][10] Most studies of platelet function, coagulation, and fibrinolysis in patients with ischemic heart disease have focused on acute coronary syndromes. 1,2,[11][12][13][14][15] However, no study has examined angiographic findings and hematologic parameters to determine which characteristics place patients with stable ischemic heart disease at risk of transition to acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

Shear‐induced platelet aggregation increases in patients with proximal and severe coronary artery stenosis

Kawano

Yoshino

Aoki

et al. 2002

Clinical Cardiology

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SummaryBackground: Shear stress generated in stenosed arteries promotes platelet thrombi formation at the stenosed sites by accelerating the binding of von Willebrand factor (vWF) to platelets. Shear-induced platelet aggregation (SIPA) has been studied in acute coronary syndromes, but not in chronic coronary disease.Hypothesis: We investigated the effect of both the site and severity of coronary stenosis on SIPA in patients with chronic coronary artery disease.Methods: Shear-induced platelet aggregation was measured using platelet-rich plasma in 49 patients (41 men and 8 women; mean age 61 ± 10 years) with coronary artery disease to evaluate the association between the extent of SIPA and coronary angiographic findings. Stenoses > 75% were considered severe. In all, 62 healthy individuals (54 men and 18 women; mean age 45 ± 7 years) served as controls. The correlation between SIPA and the site and severity of the coronary lesion, and parameters of coagulation and fibrinolysis were evaluated.Results: Shear-induced platelet aggregation was increased in the stenosis group (69.0 ± 10.6%) compared with the controls (57.7 ± 10.3%, p < 0.0001). Patients with severe stenosis in the proximal segments had significantly increased SIPA (p< 0.0001) and vWF larger multimer concentration (p < 0.0001) compared with the control group. A significant correlation existed between SIPA and the vWF larger multimer concentration in all subjects studied (r = 0.422, p < 0.0001).

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“…4 Fluctuations in coagulation factor levels able to influence the hemostatic balance might contribute to these adverse outcomes. Diurnal rhythms in levels of factor VII (FVII), 5 FVIII, 6 proteins C and S 7 , antithrombin, 7 and plasminogen activator inhibitor (PAI)-1 8 have been described in healthy humans. Temporal oscillations in prothrombin fragment F 1ϩ2 [5][6] and D-dimer, 6 markers of thrombin generation and fibrinolysis, have been also described.…”

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confidence: 99%

Daily and Circadian Rhythms of Tissue Factor Pathway Inhibitor and Factor VII Activity

Pinotti

Bertolucci

Portaluppi

et al. 2005

ATVB

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Objective-Diurnal variations in levels of factor VII (FVII), FVIII, proteins C and S, antithrombin, plasminogen activator inhibitor-1, prothrombin fragment F 1ϩ2 , and D-dimers in healthy humans point to the existence of circadian rhythms of coagulation factors. We sought for temporal fluctuations of tissue factor pathway inhibitor (TFPI) activity in human and mouse plasma. Methods and Results-TFPI activity showed significant daily variations with highest levels in the morning in healthy men (ϩ11%) and in mice at the light-to-dark transition (ϩ63%), the beginning of the physically active period. Variations in FVII activity paralleled those in TFPI. In mice, the feeding schedule had a strong impact on these rhythms. Although restricted feeding and fasting shifted the peak of TFPI, the FVII peak disappeared. Investigation of temporal fluctuations in constant darkness indicated the existence of daily rhythms for TFPI and of true circadian rhythms for FVII. Conclusions-For the first time, we report, both in humans and mice, temporal variations in TFPI activity. The coherent variations in FVII and TFPI activity could interplay to maintain the coagulation equilibrium. The chronobiological patterns should be considered to analyze activity levels of these factors. Moreover, the mouse model could be exploited to investigate modifiers of coagulation rhythms potentially associated to morning peaks of cardiovascular events. Key Words: factor VII Ⅲ TFPI Ⅲ circadian Ⅲ feeding schedule Ⅲ mouse model F requencies of thromboembolic events in humans exhibit marked diurnal variations, 1-3 with peaks from morning to noon. Temporal variations in the occurrence of hemorrhagic events have also been reported. 4 Fluctuations in coagulation factor levels able to influence the hemostatic balance might contribute to these adverse outcomes. Diurnal rhythms in levels of factor VII (FVII), 5 FVIII, 6 proteins C and S 7 , antithrombin, 7 and plasminogen activator inhibitor (PAI)-1 8 have been described in healthy humans. Temporal oscillations in prothrombin fragment F 1ϩ2 5-6 and D-dimer, 6 markers of thrombin generation and fibrinolysis, have been also described. These variations could reflect the existence of circadian rhythms of blood coagulation factors. Circadian rhythms are the overt expression of an internal timing mechanism measuring daily time, with the fundamental adaptive function of providing optimal temporal organization of physiological processes in relation to the environment. 9 Because formal assessment of circadian rhythms in coagulation factor levels is hardly feasible in humans, a circadian control has been so far demonstrated in a mouse model for PAI-1 10 -11 and fibrinogen 12 mRNA expression.Among factors interacting with circadian rhythms, daily availability of food represents a major component. Several studies suggested that postprandial and fasting lipoproteins are associated with plasma levels or activation state of coagulation factors, and particularly of FVII 13-17 that plays a key role in the initiation of the clott...

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Morning Hypercoagulability and Hypofibrinolysis

Abstract: Our data suggest that the diurnal changes in the plasma levels of activators and inhibitors of coagulation and fibrinolysis lead to corresponding changes in the activity state of these systems, leading to morning hypercoagulability and hypofibrinolysis.

Cited by 125 publications

References 23 publications

Chronobiological Patterns of Acute Aortic Dissection

Chronobiological Patterns of Acute Aortic Dissection

Shear‐induced platelet aggregation increases in patients with proximal and severe coronary artery stenosis

Daily and Circadian Rhythms of Tissue Factor Pathway Inhibitor and Factor VII Activity

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