Hemostatic risk factors in patients with coronary artery disease and type 2 diabetes - a two year follow-up of 243 patients

Abstract

BackgoundThrombosis is regarded to be a key factor in the development of acute coronary syndromes in patients with coronary artery disease (CAD). We hypothesize, that hemostatic and rheological risk factors may be of major relevance for the incidence and the risk stratification of these patients.MethodsIn 243 patients with coronary artery disease and stable angina pectoris parameters of metabolism, hemostasis, blood rheology and endogenous fibrinolysis were assessed. Patients were prospectively followed for 2 years in respect to elective revascularizations and acute coronary syndromes.ResultsDuring follow-up 88 patients presented with cardiac events, 22 of those were admitted to the hospital because of acute events, 5 Patients were excluded due to non- cardiac death. Patients with clinical events were found to be more frequently diabetic and presented with a more progressed coronary atherosclerosis. Even though patients with diabetes mellitus demonstrated a comparable level of multivessel disease (71% vs. 70%) the rate of elective revascularization was higher (41% vs. 28%, p < 0.05). The results were also unfavorable for the incidence of acute cardiovascular events (18% vs. 8%, p < 0.01). In comparison to non-diabetic patients diabetics demonstrated significantly elevated levels of fibrinogen (352 ± 76 vs. 312 ± 64 mg/dl, p < 0.01), plasma viscosity (1.38 ± 0.23 vs. 1.31 ± 0.16 mPas, p < 0.01), red blood cell aggregation (13.2 ± 2.5 vs. 12.1 ± 3.1 E, p < 0.05) and plasmin-activator-inhibitor (6.11 ± 3.4 vs. 4.7 ± 2.7 U/l, p < 0.05).ConclusionPathological alterations of fibrinogen, blood rheology and plasminogen-activator-inhibtor as indicators of a procoagulant state are of major relevance for the short-term incidence of cardiac events, especially in patients with diabetes mellitus type 2, and may be used to stratify patients to specific therapies.

Novel pathway of iron‑induced blood coagulation: implications for diabetes mellitus and its complications

“…23 The role of blood coagulation and the persistent presence of fibrin in glomerular sclerosis were emphasized by Hertig and Rondeau in 2004. 24 Fibrin-like material present in diseased glomeruli, often referred to as fibrinoid, identified by specific histochemical and/or immunological methods, 25 is similar to that demonstred with SEM in plasma (FIGURE 5A) and whole blood (FIGURE 5b) of diabetic patients.…”

Influence of type 2 diabetes mellitus on Khorana venous thromboembolism risk in colorectal cancer patients

“…(22,23). Chronic hyperglycemia can cause glycosylation of a variety of body proteins (24,25) stimulating the secretion of tumor necrosis factor and interleukin 1 of macrophages, which can promote the generation of thrombin and the activation of blood coagulation factor X (26). In addition, a high blood sugar level is correlated with shortened clotting time, reflecting the association between hyperglycemia and hypercoagulability (23).…”

Cardiovascular Risks of Anemia Correction with Erythrocyte Stimulating Agents: Should Blood Viscosity Be Monitored for Risk Assessment?

“…Even so, studies of WBV and its role in cardiovascular disease have been accelerating in recent years with the knowledge that WBV is a major determinant of the work of the heart and the perfusion of tissues throughout the body. Moreover, WBV has been independently correlated with the major risk factors for cardiovascular disease [24][25][26][27][28][29][30][31][32][33][34][35][36][37]. WBV has also been found to play an important role in the pathogenesis of atherosclerosis [38][39][40][41].…”