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Type 2 Diabetes Is Associated with Increased Coagulation Activity in Patients with Atrial Fibrillation: A

Paul Gabriel Ciubotaru1, Amit Kohli2, Nilima Rajpal Kundnani3,4

  • 1Department V, Internal Medicine I-Discipline of Medical Semiology I, Center of Advanced Research in Cardiology and Hemostasology, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.

Biomedicines
|February 27, 2026
PubMed

Insights

Type 2 diabetes mellitus (T2DM) in atrial fibrillation (AF) patients is linked to higher D-dimer levels, indicating increased coagulation. This suggests a diabetes-associated hypercoagulable AF phenotype, independent of stroke risk factors.

Area of Science:

  • Cardiology
  • Endocrinology
  • Hematology

Background:

  • Atrial Fibrillation (AF) increases stroke risk due to a prothrombotic state.
  • Type 2 Diabetes Mellitus (T2DM) is a common comorbidity in AF patients, independently raising thromboembolic risk.
  • The impact of T2DM on D-dimer levels in AF patients requires further real-world characterization.

Purpose of the Study:

  • To investigate the independent association between T2DM and plasma D-dimer levels in non-valvular AF patients.
  • To analyze D-dimer levels across different CHA2DS2-VASc risk categories in AF patients with and without T2DM.
  • To assess the role of T2DM in exacerbating the prothrombotic state in AF.

Main Methods:

  • Retrospective, observational study of 300 non-valvular AF patients.
  • Stratification into two groups: 150 with T2DM and 150 without diabetes.
  • Multivariable regression models adjusted for clinical factors, renal function, and anticoagulation status.

Main Results:

  • Patients with T2DM had significantly higher D-dimer levels (median 0.94 vs. 0.63 µg/mL FEU, p < 0.001).
  • T2DM was independently associated with elevated D-dimer levels and increased odds of exceeding thresholds (0.5 and 1.0 µg/mL FEU).
  • Higher D-dimer concentrations in T2DM patients were consistent across all CHA2DS2-VASc risk categories.

Conclusions:

  • T2DM is independently associated with increased coagulation activity in AF patients, evidenced by higher D-dimer levels.
  • Findings support a distinct 'diabetes-associated hypercoagulable AF phenotype'.
  • Coagulation biomarkers like D-dimer may refine risk stratification in AF patients with T2DM.

Keywords:
CHA2DS2-VASc scoreD-dimercardiometabolic risk factorsheart failurestroke

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