title: Circadian pattern of acute variceal bleeding among cirrhotic Egyptian patients.
abstract: BACKGROUND
  Liver cirrhosis is the most common cause of portal hypertension which may end in serious bleeding from gastro-esophageal varices. Recent studies have demonstrated a daily pattern of acute upper gastrointestinal bleeding in patients with liver cirrhosis evidenced by one or two peaks throughout the day.
  
  
  OBJECTIVE
  The assessment of the circadian rhythm of acute variceal bleeding with the possible participation of circadian changes of the fibrinolytic parameters.
  
  
  METHODS
  The study included 264 patients with liver cirrhosis and upper gastrointestinal bleeding in addition to 20 healthy subjects as a control group. A series of hemostatic tests and parameters including prothrombin (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib), Factors II, V, VII, IX, X, XI, platelets counts and fibrinolytic parameters assessement were completed in 60 patients in addition to the control group. The fibrinolytic activity was assessed by estimation of plasminogen, tissue plasminogen activator antigen (tPA: Ag) and plasminogen activator inhibitor antigen (PAI-1: Ag) at hour 09:00 and hour 17:00. The hemostatic tests and liver function tests were assessed once at hour 09.00.
  
  
  RESULTS
  We observed statistically significant two time peaks of upper gastrointestinal bleeding at hour 04:00 and hour 17:00 with a peak of the fibrinolytic parameter, tissue plasminogen activator antigen, with the night peak of bleeding. A significant correlation between the levels of fibrinolytic parameters and hemostatic factors as well as liver function tests were detected.
  
  
  CONCLUSIONS
  There are two time peaks of upper gastrointestinal bleeding with a temporal association between the night peak and a relative hyperfibrinolytic state.
authors.affiliation: Internal Medicine Faculty of Medicine, Mansoura University, Mansoura, Egypt  ; Hematology Unit, Clinical Pathology Departments Faculty of Medicine, Mansoura University, Mansoura, Egypt  ; Institute of Immunogenetic, Menofyia University, Menofyia, Egypt.
authors.forename: Salah
authors.initials: S
authors.lastname: Aref
authors.forename: Ehab E
authors.initials: EE
authors.lastname: Abdel-Khalek
authors.forename: Ibrahim A
authors.initials: IA
authors.lastname: Abdel-Aal
authors.forename: Mohammed El
authors.initials: ME
authors.lastname: Refaie
keywords: Circadian pattern; Fibrinolysis; Liver cirrhosis; Variceal bleeding