Coagulation pathways and diabetic retinopathy: abnormal modulation in a selected group of insulin dependent diabetic patients

Giusti, C; Schiaffini, Riccardo; Baratto, Claudia; Pantaleo, Antonio; Gargiulo, Patrizia

doi:10.1136/bjo.84.6.591

Cited by 16 publications

(11 citation statements)

References 42 publications

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“…This retrospective study is the first of its kind to phenotype pre‐incisional fibrinolysis in pancreas transplantation and uncover the association of FS and hyperfibrinolysis with higher venous TSS, showing a U‐shape distribution. Our results are in agreement with the deleterious implications of FS in diabetes and renal failure, and in liver and visceral transplantation . Arguably, the insensitivity of viscoelastometry to platelet dysfunction limits its usefulness in a risk‐stratified approach to thromboprophylaxis in pancreas transplantation, unless a special platelet function assay is employed, for example TEG's “Platelet Mapping,” or ROTEM's “EXTEM‐FIBTEM” assays.…”

Section: Discussionsupporting

confidence: 81%

“…As one of the three traditional factors of Virchow's triad, the prothrombotic proclivity of diabetes and end‐stage renal disease plays an important role in the pathogenesis of graft thrombosis . This hypercoagulability is due to excessive primary (ie, formation of a platelet plug) and secondary (ie, fibrin formation) hemostasis, coupled with hypofibrinolysis, a condition more commonly referred to as fibrinolytic shutdown (FS) . Reported incidences of PA thrombosis vary considerably, between 1% and 40%, but is generally described as 4‐8% .…”

Section: Introductionmentioning

confidence: 99%

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Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Raveh

Ciancio

Burke

et al. 2019

Clinical Transplantation

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Pancreas transplant achieves consistent long-term euglycemia in type 1 diabetes.Allograft thrombosis (AT) causes the majority of early graft failure. We compared outcomes of four anticoagulation regimens administered to 95 simultaneous kidney-pancreas or isolated pancreas transplanted between 1/1/2015 and 11/20/2018. Early postoperative anticoagulation regimens included the following: none, subcutaneous heparin/aspirin, with or without dextran, and heparin infusion. The regimens were empirically selected based on each surgeon's assessment of hemostasis of the operative field and personal preference. A sonographic-based global scoring system of AT is presented. The 47-month recipients and graft survival were 95% and 86%, respectively. Recipients with or without AT had similar survival. Five and four grafts were lost due to death and AT, respectively. Outcomes of prophylaxis regimens correlated with intensity of anticoagulation. Compared with no anticoagulation, an increase in hemorrhagic complications occurred exclusively with iv heparin. The higher arterial AT score found in regimens lacking antiplatelet therapy highlights the importance of early antiaggregants therapy. Abnormal fibrinolysis was associated with an increase in AT score. Platelet dysfunction, warm ischemia time, and enteric drainage were predictive of AT and, along with other known risk factors, were incorporated into an algorithm that matches intensity of early postoperative anticoagulation to the thrombotic risk.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Raveh

Ciancio

Burke

et al. 2019

Clinical Transplantation

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“…Furthermore, several reports claim that diabetes mellitus is associated with changes in the hemostatic system [6,7,8]. Such changes are more pronounced in patients with diabetic nephropathy than in diabetic patients without renal complications [9,10,11,12,13,14,] again suggesting that coagulation activation is associated with diabetic nephropathy.…”

Section: Introductionmentioning

confidence: 93%

Renal Tissue Factor Expression Is Increased in Streptozotocin-Induced Diabetic Mice

Sommeijer¹,

Florquin²,

Hoedemaker³

et al. 2005

Nephron Exp Nephrol

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Background: Tissue factor (TF) is the key initiator of the coagulation cascade. Recent evidence suggests that TF plays a role in renal fibrin formation and renal failure in experimental kidney disease. We hypothesized that hyperglycemia is an important stimulus of TF expression in the kidney. Methods: Mice were injected with streptozotocin (STZ) (200 mg/kg) or with control buffer. Three or 10 weeks after injection, fibrin, thrombin and TF staining and TF activity were evaluated in the kidney. The effect of hyperglycemia on TF expression and secretion by tubular epithelial cells was measured in vitro. Results: Kidneys of STZ-treated mice showed a marked increase in thrombin staining (3.0 ± 0.5 vs. 1.2 ± 0.11) (p = 0.002) and an increase in TF clotting activity 10 weeks after STZ injection (33.9 ± 1.3 vs. 25.4 ± 1.0 s) (p < 0.0001). Increased glomerular fibrin deposition was present in 3 out of 6 diabetic mice. Tubular cells incubated with D-glucose (25 mmol/l) for 48 h displayed increased cellular TF (p = 0.05). However, soluble TF levels and TF activity in supernatant of cells incubated with D- or L-glucose were not different. Conclusions: These data suggest that hyperglycemia is a causal factor in procoagulant activity associated with diabetic nephropathy.

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“…In T1DM, evidence of coagulation activation has been described in patients with microvascular complications. This includes increased thrombin–antithrombin complex, plasma factor VII coagulant activity and D‐dimers (11, 12). In addition, several studies have described an increased carotid artery intima‐media thickness in children and adolescents with T1DM (13–15).…”

Section: Discussionmentioning

confidence: 99%

Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature

Mah

Hill

et al. 2006

Pediatr Diabetes

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Neurological deterioration in children with diabetic ketoacidosis (DKA) is commonly caused by cerebral edema. However, stroke should also be suspected when focal neurological deficits are apparent, because children with hyperglycemia and DKA are prone to thrombosis. We report three cases of pediatric stroke associated with new onset type 1 diabetes mellitus (T1DM). The first case presented with sinovenous thrombosis, and the other two cases presented in DKA and had a late diagnosis of ischemic stroke following neurological deterioration. Our recent experiences and review of the literature emphasize the importance of early diagnosis, investigation, and treatment for patients that present with new onset T1DM and stroke.

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Coagulation pathways and diabetic retinopathy: abnormal modulation in a selected group of insulin dependent diabetic patients

Abstract: (Br J Ophthalmol 2000;84:591-595)

Cited by 16 publications

References 42 publications

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Susceptibility‐directed anticoagulation after pancreas transplantation: A single‐center retrospective study

Renal Tissue Factor Expression Is Increased in Streptozotocin-Induced Diabetic Mice

Pediatric stroke associated with new onset type 1 diabetes mellitus: case reports and review of the literature

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