Impaired circadian variations of haemostatic and fibrinolytic parameters in tetraplegia.
Spinal cord injured patients are at increased risk of developing deep vein thrombosis (DVT). Whether these patients have increased blood levels of prothrombotic markers remains to be clarified. In general, the risk of developing DVT is highest in the morning hours. In healthy humans, several haemostatic and fibrinolytic parameters exhibit circadian variations, but it is not known whether this also applies to those with spinal cord injury. The aim of the present study was to examine possible circadian variations in prothrombotic markers in tetraplegic patients. We studied six patients with complete tetraplegia and eight control subjects with repetitive blood sampling over a 24 h period. While the control subjects showed marked circadian variations in factor VIII activity, prothrombin fragments 1+2 and D-dimer levels, the tetraplegic patients did not (P < 0.05). Circadian variation in plasminogen activator inhibitor type-1 was present in both groups, being most marked (P < 0.05) in tetraplegia. We conclude that the circadian variations of several factors of the haemostatic and fibrinolytic systems are impaired in spinal cord injury. This could possibly reflect a deregulated autonomic nervous system, leading to a dysfunctional link between central and peripheral circadian oscillators.
Iversen
Per Ole
PO
Department of Haematology, Ullevaal University Hospital, Oslo, Norway. poiversen@hotmail.com
Groot
Patricia D E
PD
Hjeltnes
Nils
N
Andersen
Trine Opstad
TO
Mowinckel
Marie Christine
MC
Sandset
Per Morten
PM
D000328:Adult; D002940:Circadian Rhythm; D005169:Factor VIII / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis; D006487:Hemostasis; D006801:Humans; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011782:Quadriplegia / Q000097:blood / Q000209:etiology / Q000503:physiopathology*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000097:blood / Q000150:complications; D020246:Venous Thrombosis / Q000209:etiology
D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C036309:fibrin fragment D; D005169:Factor VIII; D005340:Fibrinogen