Is diabetes a hypercoagulable state? A critical appraisal

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Hematology

Background:

• Diabetes mellitus (DM) is a global health concern and a known risk factor for arterial vascular diseases.
• The association between DM and venous thromboembolism (VTE) or cardioembolic events in atrial fibrillation (AF) patients is less clear but increasingly recognized.
• DM is linked to higher AF incidence and increased cardioembolic risk in AF patients, leading to its inclusion in risk scores like CHA2DS2-VASc.

Purpose of the Study:

• To explore the complex relationship between diabetes mellitus and thromboembolic events.
• To highlight the potential prothrombotic state associated with DM.
• To identify the knowledge gap regarding the effect of glucose-lowering drugs on VTE and cardioembolic events in diabetic patients.

Main Methods:

• Review of existing literature on diabetes, VTE, AF, and arterial thromboembolism.
• Analysis of studies investigating cardiovascular risk factors and their association with thrombotic events.
• Examination of the role of DM in the development and progression of AF and associated cardioembolic risks.

Main Results:

• DM is associated with an increased risk of arterial thrombotic events (myocardial infarction, stroke, peripheral artery disease).
• Evidence suggests DM is linked to a higher risk of developing AF and an increased risk of cardioembolic stroke/systemic embolism in AF patients.
• DM contributes to a prothrombotic state, potentially explaining the high incidence of thromboembolic events.

Conclusions:

• Diabetes mellitus is a significant risk factor for both arterial and venous thromboembolic events.
• The prothrombotic state in DM patients warrants further investigation.
• There is a critical need for studies evaluating the impact of glucose-lowering therapies on thromboembolic risk in diabetic individuals.