Differences in thrombus structure and kinetics in patients with type 2 diabetes mellitus after non ST elevation acute coronary syndrome

Autor: Girish N. Viswanathan, Azfar Zaman, Juan J. Badimon, Sally M. Marshall, Karthik Balasubramaniam
Rok vydání: 2014
Předmět:
Whole blood thrombus
Male
HDL
High density lipoprotein
endocrine system diseases
Non ST elevation acute coronary syndrome
TEG
Thromboelastography
chemistry.chemical_compound
High-density lipoprotein
PRU
Platelet reactivity index
SEM
Scanning electron microscopy
T2DM
Type 2 diabetes mellitus
Thrombus kinetics
Secondary prevention
medicine.diagnostic_test
ST elevation
Regular Article
HOTR
High on treatment platelet reactivity
Hematology
Middle Aged
Clopidogrel
NSTE-ACS
Non ST elevation acute coronary syndrome
Cardiology
Female
medicine.medical_specialty
Acute coronary syndrome
Ticlopidine
L parameter
Thrombus lysis parameter
Fibrin structure
Internal medicine
Type 2 diabetes mellitus
medicine
Humans
In patient
cardiovascular diseases
Acute Coronary Syndrome
Thrombus
Aged
Aspirin
business.industry
Antiplatelet therapy
nutritional and metabolic diseases
Type 2 Diabetes Mellitus
Thrombosis
ARU
Aspirin reactivity index
medicine.disease
Thromboelastography
Surgery
LDL
Low density lipoprotein
Diabetes Mellitus
Type 2
chemistry
business
Platelet Aggregation Inhibitors
CI
Clot index
Zdroj: Thrombosis Research. Supplement
ISSN: 0049-3848
DOI: 10.1016/j.thromres.2014.01.033
Popis: Introduction Despite optimal secondary prevention therapy following non-ST elevation acute coronary syndrome (NSTE-ACS), recurrent thrombotic events are more frequent in patients with type 2 diabetes mellitus (T2DM). Materials and Methods This exploratory study was aimed to evaluate quantitative and qualitative aspects of thrombus. In 28 patients with and without T2DM treated with aspirin and clopidogrel we assessed thrombus quantity using an ex-vivo chamber, platelet reactivity, thrombus ultrastructure and thrombus kinetics one week after NSTE-ACS. Results T2DM was associated with increased thrombus [14861 (8003 to 30161) vs 8908 (6812 to 11996), μ2/mm, median (IQR), p = 0.045] and platelet reactivity. In addition, diabetic thrombus showed lower visco-elastic tensile strength [(− 0.2(− 1.7 to 0.7) vs 1.0(− 0.9 to 3.3), p = 0.044)] and was more resistant to autolysis [(27.8(11.7 to 70.7) vs 78.8(68.5 to109.6) mm/min, p = 0.002)]. On SEM, fibrin fibres in diabetes were thinner, with higher lateral interlinkage and mesh-like organisation. Thrombus quantity correlated inversely with thrombus retraction (r = − 0.450 p = 0.016) but not with platelet reactivity (r = 0.153, p = 0.544). Conclusions Despite optimal antiplatelet therapy, T2DM patients after NSTE-ACS developed increased thrombus of lower tensile strength and slower retraction. SEM revealed loosely arranged fibrin fibres. Our data showed significant differences in the magnitude as well as structural and mechanistic characteristics of thrombus in patients with T2DM.
Databáze: OpenAIRE
Externí odkaz: