Diabetes mellitus: a hypercoagulable state

Area of Science:

• Cardiovascular Medicine
• Hematology
• Endocrinology

Background:

• Diabetes mellitus is a major risk factor for thrombotic events, with 80% of patients dying from thrombosis.
• Cardiovascular complications account for 75% of these deaths, with cerebrovascular and peripheral vascular events comprising the remainder.
• The vascular endothelium, crucial for preventing thrombosis, is impaired in diabetes, contributing to a prothrombotic state.

Purpose of the Study:

• To review the evidence supporting diabetes as a hypercoagulable state.
• To explore the roles of hyperglycemia and hyperinsulinemia in the development of this prothrombotic condition.

Main Methods:

• Review of published literature on coagulation, fibrinolysis, and platelet function in diabetes.
• Analysis of markers for coagulation activation, clotting factor levels, and anticoagulant protein levels.
• Assessment of fibrinolytic system activity and platelet hyperactivity indicators.

Main Results:

• Elevated markers of coagulation activation (e.g., prothrombin fragment 1+2, thrombin-antithrombin complexes).
• Increased plasma levels of multiple clotting factors (fibrinogen, factors VII, VIII, XI, XII, kallikrein, von Willebrand factor) and decreased levels of anticoagulant protein C.
• Inhibited fibrinolysis due to resistant clot structures and increased plasminogen activator inhibitor type 1 (PAI-1), alongside evidence of platelet hyperactivity.

Conclusions:

• Diabetes is characterized by a hypercoagulable state, increasing the risk of thrombotic and cardiovascular events.
• Endothelial dysfunction, coagulation activation, impaired fibrinolysis, and platelet hyperactivity are key contributors.
• Hyperglycemia and hyperinsulinemia are implicated as potential drivers of these hemostatic abnormalities.