Association of activated partial thromboplastin time and fibrinogen level in patients with type II diabetes mellitus

Abstract

BackgroundPatients with diabetes mellitus have a high risk of atherothrombotic events. Diabetes contributes for initiation and progression of microvascular and macrovascular complications. Shortened activated partial thromboplastin time (aPTT) values may reflect hypercoaguable state, which is associated with increased thrombotic risk and adverse cardiovascular events. Increased level of fibrinogen is common in type II diabetes. The present study was conducted to study the aPTT and fibrinogen levels in diabetics in a tertiary care Teaching Hospital of Nepal.MethodsObservational study was performed at out-patients visiting Pathology Department at Tribhuvan University Teaching Hospital from August 5 to September 7, 2012. Research protocol was approved by Institutional Review Board at Tribhuvan University Institute of Medicine. Altogether 90 people who came to the hospital during study period and who met inclusion criteria were selected, out of which 72 were diabetics and 18 were normal controls. Diabetic cases were identified via verbal interview with patients themselves and review of laboratory findings and diagnosis performed by their physicians. Diabetics with a diabetic history of more than one year and stabilized with antidiabetic medicines such as insulin, metformin, glibenclamide, and gliclazide and diabetics with controlled diabetes as revealed by HbA1c in the range 6.2-7% were taken for the study purpose. Data were analyzed with chi square test and Fischer’s exact test (when each cell frequency was less than 5) using Statistical Package for Social Sciences 17.ResultsMaximum (53; 73.6%) diabetics and all non-diabetics had aPTT in the range 26–40 seconds. Maximum (51; 70.8%) patients had fibrinogen beyond 351 whereas all non-diabetics had fibrinogen in the range 151–350. Mean aPTT values of the diabetic patients and non-diabetic persons were 29.88 ± 4.89 seconds and 32.44 ± 2.25 seconds respectively. Mean fibrinogen values of the diabetic patients and non-diabetic persons were 388.57 ± 60.90 mg/dL and 320.89 ± 10.20 mg/dL respectively. Test data identified in results were statistically significant for aPTT (p value 0.000) and fibrinogen (p value 0.000) between the diabetics and non-diabetics.ConclusionsDiabetics have an increased level of fibrinogen and relatively shortened aPTT as compared to the non-diabetic patients.

Diabetes mellitus: A review of some of the prognostic markers of response to treatment and management

“…The observation of Sapkota et al 71 regarding shortened APTT strongly agree with the findings of Zhao et al 72 and Sauls et al 73 but were prolonged for DM patients under treatment. It would thus be safe to predict that APTT and plasma fibrinogen exhibit a negative correlation and that further prolonging the APTT of DM patients in response to treatment and management of the disease could be important in monitoring the patients.…”

“…In an experiment to support the above claims, Sapkota et al 71 report that approximately 74% of DM patients and all non-DM persons had APTT in the range of 26-40 s; mean APTT values of the DM patients and non-diabetic persons were approximately 30 s and 32 s, respectively. The observation of Sapkota et al 71 regarding shortened APTT strongly agree with the findings of Zhao et al 72 and Sauls et al 73 but were prolonged for DM patients under treatment.…”

“…In a study carried out by Coban et al, 65 the levels of plasma fibrinogen in patients with T2DM, impaired fasting glucose, and normal subjects were 449 (306-605) mg/dL, 348 (264-468) mg/dL and 216 (179-260) mg/dL, respectively, suggesting a significant correlation between fibrinogen and glycaemia. Sapkota et al 71 report that approximately 71% of DM patients had plasma fibrinogen < 351 mg/dL, whereas all non-DM persons had fibrinogen in the range of 151 mg/ dL-350 mg/dL; they also report mean fibrinogen values of DM patients and non-DM persons to be 389 mg/dL and 321 mg/dL, respectively. Thus, it would not be out of place to claim that plasma fibrinogen could be a very prognostic marker in monitoring the response of DM patients to medical interventions and drugs.…”

Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) in Type 2 Diabetes Mellitus, a Case Control Study

“…Together they contribute to a hypercoagulable state in DM. Hypercoagulability in diabetes may accelerate atherosclerosis and acts as a risk factor for the development of cardiovascular diseases(CVD) 7 Measurement of prothrombin time (PT), activated partial thromboplastin time (APTT), bleeding time and clotting factor concentration are usually done in patients with a suspected abnormal coagulation. PT and APTT are the markers for activation of extrinsic and intrinsic pathway respectively.…”

Coagulation Impairment in Type 2 Diabetes Mellitus

“…The hypercoaguability state demonstrated by shortened PT and APTT in DM may cause occlusive thrombus within a coronary artery 13 . Therefore shortened PT and APTT value is the risk factors for thromboembolic cardiovascular disease in type 2 diabetic patients 14 .…”