From the Guidelines
Thrombotic strokes occur more frequently in the early morning due to a combination of physiological changes, including increased blood pressure, hypercoagulability, and hyper-reactivity of platelets, as explained by the circadian variation of STEMI 1. These changes create a perfect storm for thrombotic events, with the body's natural circadian rhythm affecting hormone levels, such as cortisol and catecholamines, which rise in the morning and can increase blood pressure and heart rate. Some key factors contributing to this increased risk include:
- Increased vascular tone and blood pressure due to β-adrenergic stimulation 1
- Hypercoagulability of the blood, with higher levels of clotting factors like fibrinogen and platelets peaking in the early morning hours
- Hyper-reactivity of platelets, which can initiate mural thrombus formation 1
- Dehydration that occurs overnight, further concentrating the blood and making it stickier and more likely to form clots For those at risk of stroke, taking preventative medications like aspirin, statins, or blood pressure medications in the evening rather than morning may provide better protection during these vulnerable hours. Additionally, maintaining consistent sleep patterns, gradually rising from bed, staying hydrated, and avoiding sudden strenuous activity immediately upon waking can help reduce the risk of morning strokes. The physiological changes that occur in the early morning hours, as described in the context of STEMI 1, can be applied to understand the increased risk of thrombotic strokes during this time.
From the Research
Thrombotic Strokes in Early Morning
- Thrombotic strokes are more likely to occur in the early morning hours, with the greatest portion of strokes (32.5%) occurring between 03:00 and 06:00 a.m. 2
- The exact reason for this increased risk is not fully understood, but it may be related to physiological mechanisms, cold weather, or religious factors 2
- Studies have shown that the risk of stroke is higher in the early morning hours and lower during nighttime hours 2
Physiological Mechanisms
- Physiological mechanisms, such as changes in blood pressure, heart rate, and blood clotting, may contribute to the increased risk of thrombotic strokes in the early morning hours 2
- The body's natural circadian rhythm may also play a role in the increased risk of stroke during this time period 2
Prevention and Treatment
- Anticoagulants and antiplatelet agents may be used to prevent and treat thrombotic strokes, but their effectiveness and safety vary depending on the individual and the specific medication 3, 4, 5, 6
- The use of anticoagulants and antiplatelet agents should be carefully considered and monitored to minimize the risk of bleeding and other adverse effects 3, 4, 5, 6