Diabetes Mellitus: Hypercoagulability Aid Hypofibriholysis

Abstract

A hypercoagulable state has been related to the presence of microvascular and macrovascular disease in Diabetes Mellitus. The aim of this study was to establish when this hypercoagulable state appears and the response of the fibrinolytic system.43 patients (29 males, 14 females, aged 19-73), 28 insulin-dependent (10 of them with micro and/or macrovascular disease), 15 non insulin- dependent (all of them with vascular disease) were studied.Platelet aggregation and adenine nucleotides, plasma and serum thromboxane B2 (TxB2), Factor VIII Coagulant (VIII-C), Factor VIII Related antigen (VIII-RAg), Factor VIII Ristocetin Cofactor (VIII-RCoF), Fibronectin, Tissue Plasminogen Activator (t-PA) and X-Oligomers fibrin fragments were measured.In the diabetic patients maximal aggregation was induced by a threshold concentration of adenosin diphosphate and arachidonic acid lower than in controls (p<0.01 and p<0.05). Diabetic patients also presented elevated platelet ADP and decreased platelet c-AMP. They had higher plasma TxB* levels than the control group.FVIII-C, FVIII-RAg and Fibronectin were increased (p<0.001) both in patients type I and II, with and without vasculopathy. FVIII-RCoF was highly increased in vasculopathy (p<0.001) while was non significant without it.The patients with vasculopathy presented decreased t-PA plasma levels (p<0.05). lo difference in X-Oligomers was found related to controls.These findings suggest: 1) A hypercoagulable state previously to the development of clinical vasculopathy. 2) A decreased fibrinolytic response associated to vasculopathy.