Abstract Number: PB1045
Meeting: ISTH 2021 Congress
Background: Diabetes mellitus (DM) is associated with increased risk of cardiovascular disease although there are no current coagulation studies that predict thrombotic risks.
Aims: To investigate the utility of global coagulation assays and endothelial biomarkers in diabetic patients compared to healthy controls.
Methods: Diabetic patients, not on anticoagulation and without active malignancy, were recruited from endocrinology outpatients. Blood samples were collected for baseline tests and global coagulation assays including thromboelastography (TEG), calibrated automated thrombogram (CAT) and overall haemostatic potential (OHP) assay as well as tissue factor pathway inhibitor (TFPI) and plasminogen activator inhibitor-1 (PA1-1). The results were compared to previously recruited healthy controls (n=153).
Results: 184 patients consisting of 22 type 1 DM (T1DM), 154 type 2 DM (T2DM) and 8 latent autoimmune diabetes in adults (LADA) were recruited. Compared to healthy controls, diabetic patients demonstrated more hypercoagulable TEG parameters with increased clot strength (maximum amplitude, 68.7 vs 60.5 mm, p<0.001). While there was no difference in thrombin generation (CAT), the OHP assay demonstrated significantly higher fibrin generation and lower overall fibrinolytic potential (OFP 73.6 vs 81.1%, p<0.001). TFPI was significantly increased in diabetic patients (36.9 vs 14.5 ng/mL, p<0.001) while PAI-1 was comparable (p=0.14). On sub-analysis, T2DM patients were more hypercoagulable than T1DM patients on thromboelastography, and fibrin generation with higher PAI-1 (14.8 vs 8.7 ng/mL, p=0.017) but comparable for other assays. T1DM patients with known diabetic complications had lower OFP than those without complications while T2DM with known complications had higher thrombin generation parameters with reduced OFP.
|Global coagulation assay parameters||Units||Normal controls (n=153)||All Diabetics (n=184)||P values*|
|Thromboelastography: Maximum amplitude, median (IQR)||mm||60.5 (57.2, 63.5)||69.0 (66.1, 72.6)||<0.001|
|CAT: Endogenous thrombin potential, median (IQR)||nm.min||1320 (1164, 1510)||1260 (1097, 1460)||0.061|
|CAT: Peak height, median (IQR)||nm||220.3 (173, 266.8)||211.3 (173.5, 256.0)||0.92|
|OHP: Overall coagulation potential, mean (SD)||unit||35.5 (9.7)||41.1 (10.3)||<0.001|
|OHP: Overall fibrinolytic potential, median (IQR)||%||81.1 (77.4, 84.1)||73.3 (65.1, 79.5)||<0.001|
|Biomarkers: TFPI, median (IQR)||ng/mL||14.5 (6.7, 27.6)||37.1 (2.1, 71.4)||<0.001|
|Biomarkers: PAI-1, median (IQR)||ng/mL||8.1 (2.8, 18.5)||9.9 (4.5, 20.0)||0.14|
Conclusions: Our study demonstrates that diabetic patients have a more hypercoagulable profile on global coagulation assays, particularly in T2DM patients as well as patients with known diabetic complications. Further studies with longer term follow-up are ongoing to evaluate the utility of global coagulation assays in predicting patient outcomes.
To cite this abstract in AMA style:Lim HY, Lui B, Tacey M, Kwok A, Varadarajan S, Sashindranath M, Selan C, Donnan G, Nandurkar H, Ho P. Global Coagulation Assays and Endothelial Biomarkers in Patients with Diabetes Mellitus [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/global-coagulation-assays-and-endothelial-biomarkers-in-patients-with-diabetes-mellitus/. Accessed November 29, 2023.
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