Increased thrombus formation relates to ambient blood glucose and leukocyte count in diabetes mellitus type 2

Abstract

The prevalence of atherosclerotic disease is increased in type 2 diabetes mellitus, and its thrombotic complications cause the high morbidity and mortality from coronary heart disease, cerebrovascular disease, and peripheral vascular disease. 1 Kannel W.B. D’Agostino R.B. Wilson P.W. Belanger A.J. Gagnon D.R. Diabetes, fibrinogen, and risk of cardiovascular disease the Framingham experience. Am Heart J. 1990; 120: 672-676 Abstract Full Text PDF PubMed Scopus (314) Google Scholar , 2 Grundy S.M. Benjamin I.J. Burke G.L. Chait A. Eckel R.H. Howard B.V. Mitch W. Smith S.C. Sowers J.R. Diabetes, and cardiovascular disease. A statement for healthcare professionals from the American Heart Association. Circulation. 1999; 100: 1134-1136 Crossref PubMed Scopus (1636) Google Scholar , 3 Aronson D. Rayfield E.J. Chesebro J.H. Mechanism determining course and out come of diabetic patients who have had acute myocardial infarction. Ann Intern Med. 1997; 126: 296-306 Crossref PubMed Scopus (272) Google Scholar , 4 Aronson D. Bloomgarden Z. Rayfield E.J. Potential mechanisms promoting restenosis in diabetic patients. J Am Coll Cardiol. 1996; 27: 528-535 Abstract Full Text PDF PubMed Scopus (308) Google Scholar Diabetes is known to affect the thrombogenicity of the vessel wall and circulating blood. This study aims to examine the blood thrombogenicity in diabetes by controlling the vessel wall-related factors of thrombogenicity. Hyperglycemia seems to influence the thrombogenicity of the circulating blood by the following mechanisms: (1) platelet function and aggregability are altered, 5 Davi G. Averna M. Catalano I. Barbagallo C.M. Giovenco E. Carroccio A. Notarbartolo A. Strano A. Platelet function in patients with type 2 diabetes mellitus the effect of glycaemic control. Diabetes Res. 1989; 10: 7-12 PubMed Google Scholar , 6 Rauch U. Ziegler D. Piolot R. Schwippert B. Benthake H, Schultheiss HP, Tschoepe D. Platelet activation in diabetic cardiovascular autonomic neuropathy. Diabet Med. 1999; 16: 848-852 Crossref PubMed Scopus (34) Google Scholar (2) the balance between blood coagulation and fibrinolysis is affected, 7 Ceriello A. Coagulation activation in diabetes mellitus the role of hyperglycemia and therapeutic prospects. Diabetologia. 1993; 36: 1119-1125 Crossref PubMed Scopus (278) Google Scholar , 8 Hughes A. McVerry B.A. Wilkinson L. Goldstone A.H. Lewis D. Bloom A. Diabetes, a hypercoagulable state? Hemostatic variables in newly diagnosed type 2 diabetic patients. Acta Haematol. 1983; 69: 254-259 Crossref PubMed Scopus (48) Google Scholar , 9 Rao A.K. Chouhan V. Chen X. Sun L. Boden G. Activation of the tissue factor pathway of blood coagulation during prolonged hyperglycemia in young healthy men. Diabetes. 1999; 48: 1156-1161 Crossref PubMed Scopus (99) Google Scholar and (3) leukocyte activation and procoagulant activity is increased in the diabetic state. 10 Tschoepe D. Rauch U. Schwippert B. Platelet-leukocyte cross-talk in diabetes mellitus. Horm Metab Res. 1997; 29: 631-635 Crossref PubMed Scopus (84) Google Scholar , 11 Bazzan M. Gruden G. Stella S. Vaccarino A. Tamponi G. Olivetti C. Giunti S. Cavallo-Perin P. Microalbuminuria in IDDM is associated with increased expression of monocyte procoagulant activity. Diabetologia. 1998; 41: 767-771 Crossref PubMed Scopus (14) Google Scholar Although the effects of diabetes on different platelet and leukocyte functions have already been assessed by several in vitro tests, studies evaluating thrombus formation under defined rheologic conditions that mimic in vivo blood flow in a mildly stenosed coronary artery have not been performed. To assess blood thrombogenicity independent of the effects of diabetes on the vasculature, ex vivo thrombus formation was examined by perfusing nonanticoagulated blood of patients with type 2 diabetes and of controls over a defined thrombogenic substrate. The blood thrombogenicity was correlated with ambient blood glucose level and total leukocyte count.