Clinical predictors of successful thrombolysis with Streptokinase and possible circadian periodicity

Hypothesis: Predictive strength of each predictor of successful thrombolysis is different. There is diurnal variation in the efficacy of streptokinase thrombolysis. Methodology: Retrospective study. 34 consecutive patients treated with streptokinase.ed retrospectively; success or failure of thrombolysis was determined according to accepted clinical and ECG criteria. Results: The mean age of the group with successful thrombolysis is quite younger than the group who failed. Inferior wall MI with or without posterior wall, smoker (current or ex-) and hypertensive patients had significant thrombolysis success rate than their counterparts. A definite time peak for successful thrombolysis could be detected at the afternoon and early evening hours (12.00-2100 h); 72% of all successful cases were observed in this time interval compared with 33.3% of all failed cases, while between 21.00– 24.00 h, the percentage of successes was 8% compared with 22.2 % of all failures. Conclusions: Dose adjustment for the time of day may be required, with higher doses during morning hours, or preference for primary coronary angioplasty in order to avoid the increase in bleeding complications related to higher doses of thrombolytic agents.