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The vulnerable blood. Coagulation and clot structure in diabetes mellitus
1Dr. Katharina Hess, Department of Internal Medicine I, University Hospital Pauwelsstr. 30, 52074 Aachen, Germany, Tel. +49/(0)241/803 71 28, Fax +49/(0)241/808 25 45,
Insights
Diabetes patients face higher cardiovascular risks due to blood alterations. This review explores how diabetes affects platelet function and clot structure, impacting thrombosis.
Area of Science:
- Cardiovascular Science
- Hematology
- Metabolic Disorders
Background:
- Diabetes mellitus significantly increases cardiovascular morbidity and mortality.
- While atherosclerosis is a known factor, blood alterations are increasingly recognized as critical.
- Platelet activation and fibrin clot formation are key events following plaque rupture.
Purpose of the Study:
- To review the alterations in platelet function and blood clot structure in patients with diabetes.
- To explore the underlying mechanisms, including metabolic and inflammatory processes.
- To investigate the emerging role of the complement cascade in diabetes-associated thrombosis.
Main Methods:
- Literature review of studies on diabetes, thrombosis, platelet function, and coagulation.
- Analysis of research investigating metabolic and inflammatory pathways in diabetes.
- Examination of studies on complement system components and their interaction with hemostasis.
Main Results:
- Diabetic patients exhibit a prothrombotic state characterized by hyper-reactive platelets.
- Blood clots in diabetes are tighter, more rigid, and exhibit prolonged lysis.
- Up-regulation of coagulation factors and inflammatory processes contribute to these changes.
- The complement cascade emerges as a significant modulator of platelet function and coagulation in diabetes.
Conclusions:
- Diabetes profoundly alters blood components, leading to a prothrombotic state.
- Metabolic and inflammatory changes, alongside complement activation, are key drivers.
- Understanding these hemostatic alterations is crucial for managing cardiovascular risk in diabetes.
Abstract:
Patients with diabetes are at increased risk of cardiovascular morbidity and mortality. While arteriosclerotic lesions have long been recognized as the underlying cause more recent studies suggest that alterations of the blood are also critically involved. Following plaque rupture, adherence of platelets is followed by the formation of a cross-linked fibrin clot. Patients with diabetes exhibit a prothrombotic milieu consisting of hyper reactive platelets, a tight and rigid clot structure which is due to up-regulation of coagulation factors and prolongation of clot lysis. Metabolic alterations as well as inflammatory processes, which are up-regulated in diabetes, are thought to be the main underlying causes. More recently, the complement cascade has emerged as a potential new player in this context with several complement components directly influencing both platelet function and coagulation. This review provides an overview concerning the changes that lead to alterations of platelet function and clot structure in diabetes.
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