Fibrinolytic activity is highly influenced by long‐term glycemic control in Type 1 diabetic patients

Seljeflot, Ingebjørg; Larsen, J; Dahl‐Jørgensen, Knut; Hanssen, Kristian F.; Arnesen, Harald

doi:10.1111/j.1538-7836.2006.01803.x

Cited by 16 publications

(12 citation statements)

References 18 publications

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“…Premature atherosclerosis, increased platelet reactivity and activation of coagulation factors with associated hypofibrinolysis all contribute to increased cardiovascular risk in diabetic patients. 8 9 Increased plasma levels and/or activity of haemostatic factors, including tissue factor, 22 Factor VII (FVII), 23 24 thrombin, 22 25 fibrinogen 26–28 and plasminogen activator inhibitor-1 (PAI-1), 29 30 have all been reported in diabetes patients. The pathogenesis of DIC is similar, in terms of persistent widespread activation of coagulation in the presence of underlying disease.…”

Section: Discussionmentioning

confidence: 99%

Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

et al. 2017

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ObjectivesTo determine quantitatively the association between type 2 diabetes mellitus (T2DM) and disseminated intravascular coagulation (DIC).DesignRetrospective cohort study using a claims database.SettingMedical care institutions representing 9% of all secondary hospitals (acute care hospitals) in Japan.ParticipantsIn total, 797 324 admissions, comprising 435 354 patients aged 18–79 years at the time of admission, were enrolled between January 2010 and September 2014. All patients were diagnosed with diabetes or admitted to hospitals that provided laboratory data.Main outcome measuresIncidence of DIC reported by physicians in claims data.ResultsLogistic regression analysis found that the risk of DIC was significantly higher in T2DM patients than in non-DM patients (fully adjusted OR: 1.39 (95% CI 1.32 to 1.45)), independent of age, sex, admission year and potential underlying diseases. The higher risk of DIC in T2DM patients was apparent in those who were treated with insulin within the 30-day period prior to admission (1.53 (1.37 to 1.72)). When stratified by the potential underlying diseases, the risk of DIC was higher in T2DM patients with non-septic severe infection (1.67 (1.41 to 1.97)) and with solid tumour (1.59 (1.47 to 1.72)) than in non-DM patients with those underlying diseases. The risk was similar between T2DM and non-DM patients with sepsis (0.98 (0.90 to 1.08)) and lower in T2DM patients with acute leukaemia (0.70 (0.59 to 0.84)).ConclusionsT2DM was associated with a higher risk of DIC, particularly when recently treated with insulin, as well as among admissions with solid tumour or non-septic severe infection.

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Section: Discussionmentioning

confidence: 99%

Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

et al. 2017

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“…HbA 1c , which is formed by a simple chemical reaction between hemoglobin and blood glucose, reflects the average plasma glucose level in an individual over the preceding 8–12 weeks . Experimental studies have suggested that hyperglycemia may facilitate thrombosis through activation of the coagulation system , as well as by impairing fibrinolysis , and a consistent relationship between HbA 1c and arterial cardiovascular disease (CVD) has been suggested. Furthermore, both hyperglycemia and diabetes are known risk factors for arterial thromboembolic events .…”

Section: Introductionmentioning

confidence: 99%

Hyperglycemia, assessed according to HbA1c, and future risk of venous thromboembolism: the Tromsø study

Lerstad

Brodin

Enga

et al. 2014

Journal of Thrombosis and Haemostasis

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NorwayTo cite this article: Lerstad G, Brodin EE, Enga KF, Jorde R, Schirmer H, Njølstad I, Svartberg J, Braekkan SK, Hansen J-B. Hyperglycemia, assessed according to HbA 1c , and future risk of venous thromboembolism: the Tromsø study. J Thromb Haemost 2014; 12: 313-9.Summary. Background: HbA 1c , a marker of average plasma glucose level during the previous 8-12 weeks, is associated with the future risk of cardiovascular disease and all-cause mortality. Objectives: To examine the association between hyperglycemia, assessed according to HbA 1c , and the future risk of venous thromboembolism (VTE) in a population-based cohort. Methods: HbA 1c was measured in 16 156 unique subjects (25-87 years) who participated in one or more surveys of the Tromsø study (Tromsø 4, 1994(Tromsø 4, -1995 Tromsø 5, 2001 Tromsø 5, -2002 and Tromsø 6, 2007-2008). All subjects were followed, and incident VTE events were recorded up to 31 December 2010. Results: There were 333 validated first VTE events, of which 137 were unprovoked, during a median followup of 7.1 years. HbA 1c was not associated with the future risk of VTE in analyses treating HbA 1c as a continuous variable, or in categorized analyses. The risk of VTE increased by 5% per one standard deviation (0.7%) increase in HbA 1c (multivariable-adjusted hazard ratio [HR] 1.05; 95% confidence interval [CI] 0.97-1.14), and subjects with HbA 1c ≥ 6.5% had a 27% higher risk than those with HbA 1c < 5.7% (multivariable-adjusted HR 1.27; 95% CI 0.72-2.26). There was no significant linear trend for an increased risk of VTE across categories of HbA 1c (P = 0.27). Conclusions: Serum levels of HbA1c were not associated with the future risk of VTE in multivariable analysis. Our findings suggest that hyperglycemia does not play an important role in the pathogenesis of VTE.

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“…Markers of fibrinolysis and coagulation In type 1 diabetes (DM1) patients the specific contribution of hyperglycemia to the prothrombotic state is clearer as they lack the other risk factors that confound the relationship in DM2 patients. In a long‐term follow‐up study, a highly significant correlation was found between mean HbA1c in DM1 patients over the course of 18 years and impaired fibrinolysis as represented by elevated PAI‐1 and decreased tissue plasminogen activator (t‐PA) [24]. In a smaller setting, eight DM1 patients on continuous subcutaneous insulin infusion therapy had treatment withheld for the duration of 4 h, which caused a rise of PAI‐1 and plasma TF.…”

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confidence: 99%

Hyperglycemia: a prothrombotic factor?

Lemkes¹,

Hermanides²,

DeVries³

et al. 2010

Journal of Thrombosis and Haemostasis

250

213

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Summary. Diabetes mellitus is characterized by a high risk of atherothrombotic events. What is more, venous thrombosis has also been found to occur more frequently in this patient group. This prothrombotic condition in diabetes is underpinned by laboratory findings of elevated coagulation factors and impaired fibrinolysis. Hyperglycemia plays an important role in the development of these hemostatic abnormalities, as is illustrated by the association with glycemic control and the improvement upon treatment of hyperglycemia. Interestingly, stress induced hyperglycemia, which is often transient, has also been associated with poor outcome in thrombotic disease. Similar laboratory findings suggest a common effect of acute vs. chronic hyperglycemia on the coagulation system. Many mechanisms have been proposed to explain this prothrombotic shift in hyperglycemia, such as a direct effect on gene transcription of coagulation factors caused by hyperglycemia-induced oxidative stress, loss of the endothelial glycocalyx layer, which harbours coagulation factors, and direct glycation of coagulation factors, altering their activity. In addition, both chronic and acute hyperglycemia are often accompanied by hyperinsulinemia, which has been shown to have prothrombotic effects as well. In conclusion, the laboratory evidence of the effects of both chronic and acute hyperglycemia suggests a prothrombotic shift. Additionally, hyperglycemia is associated with poor clinical outcome of thrombotic events. Whether intensive treatment of hyperglycemia can prevent hypercoagulability and improve clinical outcome remains to be investigated.

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Fibrinolytic activity is highly influenced by long‐term glycemic control in Type 1 diabetic patients

Cited by 16 publications

References 18 publications

Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

Risk of disseminated intravascular coagulation in patients with type 2 diabetes mellitus: retrospective cohort study

Hyperglycemia, assessed according to HbA1c, and future risk of venous thromboembolism: the Tromsø study

Hyperglycemia: a prothrombotic factor?

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