Evaluation of the Haemostatic System during Ketoacidotic Deterioration of Diabetes mellitus

Abstract

Clinical observations have indicated the frequent development of thrombotic complications during diabetic ketoacidosis (DKA). This study aimed to examine whether haemostatic changes that could lead to a thrombotic tendency occur during ketoacidosis. Plasma levels of in vivo haemostatic markers reflecting activation degrees of the coagulation system, fibrinolytic system, platelets and endothelium were assayed in 34 patients with DKA, both at diagnosis and 1 week after recovery. We found coagulation system and platelet activation and endothelial injury/activation in the patients at diagnosis of DKA. Although significant improvements were observed after recovery, only platelet activity was completely normalized. Fibrinolytic activity was also increased, both at diagnosis and after recovery, compared to the control group. However, although coagulation activity was prominently increased at diagnosis compared to the recovery period, there was no change in fibrinolytic activity in the same periods; on the contrary, the fibrinolytic capacity of the endothelium was diminished at diagnosis of DKA compared to the recovery period, suggesting the presence of relative hypofibrinolysis during DKA. Indications for a role of hyperglycaemia in the emergence of haemostatic disturbances during DKA were observed.

An in vitro analysis of the effect of acidosis on coagulation in chronic disease states – a thromboelastograph study

“…One of the postulates as to the cause of the procoagulant state is that DKA represents an inflammatory disease with increased C-reactive protein, cytokines and complement. 16 This is reflected in abnormal endothelial function with raised von Willebrand Factor, tissue plasminogen activator and cellular adhesion molecules.…”

Massive pulmonary embolism in diabetic ketoacidosis and non-ketotic hyperosmolar state: case series and review of the literature

“…Subsequently, these researchers reported the hemostatic alterations in 34 patients with uncomplicated diabetic ketoacidosis. 32 The authors again found evidence of endothelial injury/activation, platelet and coagulation system activation and decrease in fibrinolysis during diabetic ketoacidosis. There was significant improvement after 1 week with platelet activity returning to normal.…”

“…On the basis of these findings of enhanced coagulability, these authors raised the idea of prophylactic anticoagulation in patients with DKA. 31,32 We cared for three patients admitted with severe hyperglycemia who suffered massive pulmonary embolism within 72 hours of presentation. None had prior venous thromboembolism or cardiopulmonary symptoms or signs on presentation.…”

Cerebrovascular complications of diabetic ketoacidosis in children

“…However, evidence of increased thrombin-antithrombin complex, plasma factor VII coagulant activity, and D--dimers, besides increased intima-media thickness of the carotid artery were found in children with T1DM (6,7).…”