Study of some fibrinolytic parameters in diabetics with and without vascular complications

ABSTRACT

Aim: Hypofibrinolysis is a common finding in patients with diabetes and a risk factor for the occurrence of micro- and macroangiopathy. Type 2 diabetic patients have a high incidence of atherosclerosis and thrombosis leading to increased morbidity and mortality from coronary artery disease, cerebrovascular disease and peripheral vascular disease. The superimposition of thrombosis or atherosclerosis is associated with hypercoagulation, hypofibrinolysis and/or platelet alteration, which is caused by several factors including endothelial dysfunction, disturbed lipid metabolism, monocyte invasion and smooth muscle proliferation. The aim of the present work was to study the level of plasminogen activator inhibitor-1 [PAI-1] and D-dimer in diabetic patients with vascular complications and to compare these results with a group of diabetic patients without vascular complications. Subjects and The study was carried out on 60 female subjects; 20 healthy normal controls, 20 type 2 diabetic subjects without vascular complications and 20 type 2 diabetics with vascular complications, subdivided into 10 subjects with diabetic proliferate retinopathy as a microvascular complication and 10 subjects with coronary heart disease as a macrovascular complication. The results showed that PAI-1 and D-dimer were higher in type 2 diabetic patients as compared to the control group. Diabetic subjects with vascular complications showed higher level of PAI-1 and D-dimer as compared to those without vascular complications. The euglobulin clot lysis time [ECLT] was prolonged in type 2 diabetics in comparison to the controls. The diabetic patients with vascular complications showed also prolongation of ECLT as compared to those without vascular complications Conclusions: There is a generalized hypercoagulable state in diabetics with vascular complications and this state may play a significant role in the pathogenesis of vascular complications Therefore, good glycemic and lipid control may decrease the level of PAI-1, D-dimer and clot lysis time, so it may delay or prevent the vascular-complications of diabetes