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The pathogenesis and available prevention options in patients with diabetic thrombophilia
Jacek Kwiatkowski1, Jowita Halupczok-Żyła2, Marek Bolanowski2
1Department and Clinic of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Poland.
Insights
Diabetes mellitus (DM) causes acquired thrombophilia due to complex mechanisms affecting blood clotting. This increases cardiovascular risks and may alter medication effectiveness, necessitating awareness for better patient outcomes.
Area of Science:
- Cardiovascular Medicine
- Hematology
- Endocrinology
Background:
- Diabetes mellitus (DM) is a significant health concern associated with elevated cardiovascular and thrombotic risks.
- Diabetic thrombophilia, characterized by coagulation-fibrinolysis imbalance, is a key complication of DM.
- Multiple factors contribute to hypercoagulability in diabetes, including endothelial dysfunction, platelet alterations, and clot structure changes.
Purpose of the Study:
- To elucidate the mechanisms underlying diabetic thrombophilia.
- To investigate the impact of DM on the efficacy of antithrombotic therapies.
- To highlight the importance of recognizing thrombotic risks in diabetic patients.
Main Methods:
- Review of existing literature on diabetes, coagulation, fibrinolysis, and thrombotic complications.
- Analysis of mechanisms contributing to hypercoagulability in DM.
- Evaluation of evidence regarding the effectiveness of antithrombotic agents in diabetic patients.
Main Results:
- DM is the leading cause of acquired thrombophilia due to endothelial damage, platelet dysfunction, altered clot structure, and glycation-related protein changes.
- Evidence suggests reduced efficacy of thrombolytic drugs in diabetic patients.
- The effect of acetylsalicylic acid (ASA) on thrombotic risk in DM requires further clarification.
Conclusions:
- Diabetic thrombophilia is a multifactorial condition increasing thrombotic and cardiovascular risks.
- Understanding these mechanisms is crucial for managing diabetic patients.
- Further research is needed to optimize antithrombotic strategies, including ASA, in diabetes management.
Abstract:
Diabetes mellitus (DM), a growing health problem itself, is accompanied by an increased risk of cardiovascular and thrombotic complications. The imbalance between coagulation and fibrinolysis processes observed in patients with diabetes may be defined as diabetic thrombophilia. Several mechanisms are involved in the hypercoagulability state in diabetics, including endothelial cell damage, altered platelet structure and function, increased microparticle formation, different structure of fibrin clots, disturbances in the activity of coagulation factors, fluctuations in the concentrations of fibrinolysis activators and inhibitors, and qualitative changes of proteins due to glycation and oxidation processes. These all are the reasons why DM is the most common cause of acquired thrombophilia. Moreover, diabetes changes the efficacy of certain medications. Results of various trials seem to suggest that thrombolytic drugs are less effective in patients suffering from this disease. The impact of DM on the effectiveness of treatment with acetylsalicylic acid (ASA) remains unclear. Awareness of thrombotic complications in diabetic patients may enable earlier diagnosis and proper therapy.
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