The Prothrombotic Syndrome in Type 2 Diabetes: Assessment and Control

Abstract

High plasma levels of fibrinogen, clotting factor VII, plasminogen activator inhibitor-1 as well as of endothelia-derived von Willebrand factor are increased in patients with type 2 diabetes and are considered to be predictive for the thrombotic complications of atherosclerosis. Circumstantial evidence suggests that a peculiar association of stimuli including hyperinsulinism and the release into the portal circulation of excess free fatty acids and of proinflammatory cytokines, originating in the enlarged visceral adipose tissue, would enhance the synthesis of liver derived hemostatic variables. Glycation of antithrombin may contribute to the abnormal hemostatic balance. It should be mentioned that association of cardiovascular disease with clotting factors and antifibrinolytic potential elevations illustrates correlations not causality. The above mentioned changes of hemostatic variables are therefore relevant only in context with hyperreactive platelets and endothelial lesions or dysfunction. Correction of overweight and the improved metabolic control would however diminish the pathologically increased plasma levels of protrombothic hemostatic variables and in association with an efficient antiplatlet therapy (Clopidogrel) may reduce the thrombotic tendency.