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Published on: June 11, 2012

Hemostasis and glycemic control in the cardiac surgical patient

Thomas F Slaughter1

  • 1Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA. tslaught@wfubmc.edu

Seminars in Cardiothoracic and Vascular Anesthesia
|September 9, 2006
PubMed

Insights

Diabetes mellitus, particularly type 2, is rising due to lifestyle factors. High blood glucose and insulin levels promote blood clot formation, increasing cardiovascular risk, especially during surgery.

Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Medicine
  • Hematology

Background:

  • Diabetes mellitus affects 6% of the US population, with a significant portion undiagnosed.
  • Type 2 diabetes is increasing due to obesity, inactivity, and aging, leading to insulin resistance.
  • Diabetes is a major cause of blindness, kidney failure, and amputations, and is linked to atherothrombotic disease.

Purpose of the Study:

  • To review the association between diabetes, hyperglycemia, hyperinsulinemia, and prothrombotic states.
  • To highlight the role of hemostasis alterations in diabetes-related cardiovascular risk.
  • To emphasize the importance of perioperative glucose control.

Main Methods:

  • Review of existing literature on diabetes, hemostasis, endothelial function, and cardiovascular risk.
  • Analysis of data linking hyperglycemia and hyperinsulinemia to prothrombotic changes.
  • Examination of the inflammatory phenotype in diabetic endothelial dysfunction.

Main Results:

  • Hyperglycemia and hyperinsulinemia induce prothrombotic conditions: increased PAI-1, reduced fibrinolysis, elevated coagulation factors (fibrinogen, factor VII, factor X), and enhanced platelet activation.
  • Even minor elevations in fasting glucose increase cardiovascular risk.
  • Endothelial dysfunction with an inflammatory phenotype is common in diabetes.

Conclusions:

  • Alterations in hemostasis significantly contribute to the increased cardiovascular risk in diabetes.
  • The prothrombotic potential of hyperglycemia necessitates aggressive perioperative glucose management.
  • Controlling blood glucose is crucial for mitigating diabetes-related complications and cardiovascular events.

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