Abstract
In patients with diabetes, metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet hypersensitivity, coagulation disorders and hypofibrinolysis. Hyperglycemia and insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulatory and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with diabetes. Other coexisting factors like hypoglycemia, obesity and dyslipidemia also contribute to coagulation disorders in patients with diabetes. Management of the prothrombotic state includes antiplatelet and anticoagulation therapies for diabetes patients with either a history of cardiovascular disease or prone to a higher risk of thrombus generation, but current guidelines lack recommendations on the optimal antithrombotic treatment for these patients. Metabolic optimizations like glucose control, lipid-lowering, and weight loss also improve coagulation disorders of diabetes patients. Intriguing, glucose-lowering drugs, especially cardiovascular beneficial agents, such as glucagon-like peptide-1 receptor agonists and sodium glucose co-transporter inhibitors, have been shown to exert direct anticoagulation effects in patients with diabetes. This review focuses on the most recent progress in the development and management of diabetes related prothrombotic state.
Highlights
In 2017, the International Diabetes Federation estimated that 451 million adults are diagnosed with diabetes mellitus (DM) worldwide, and the number would increase to 693 million by 2045 [1]
This review focuses on coagulation dysfunction and prothrombotic states in patients with DM
Patients with type 2 diabetes mellitus (T2DM) had larger mean platelet volume (MPV) and increased platelet generation compared to patients having type 1 diabetes mellitus (T1DM); MPV correlated with HbA1c only in patients with T1DM [17]
Summary
In 2017, the International Diabetes Federation estimated that 451 million adults are diagnosed with diabetes mellitus (DM) worldwide, and the number would increase to 693 million by 2045 [1]. The hemostatic function of platelets and coagulation factors sometimes makes it difficult to control the pro-thrombotic state since global inhibition of coagulation will impair hemostasis [4]. It is essential to understand the signalling partners and factors involved in platelet hyperresponsiveness or aberrant activation of the coagulation system. This will eventually allow for selective targeting of pro-thrombotic cascades while preserving hemostasis. The choice and optimal dosage of antithrombotic agents for patients with DM are still unclear [8]. This review focuses on coagulation dysfunction and prothrombotic states in patients with DM
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