COAGULATION AND FIBRINOLYTIC SYSTEM IMPAIRMENT IN INSULIN-DEPENDENT DIABETES-MELLITUS

Selected coagulation and fibrinolytic parameters were assessed in 40 insulin dependent diabetes mellitus patients with varying degrees of metabolic control; 30 healthy subjects matched for age and sex formed the control group. Activated Partial Thromboplastin Time, Prothrombin Time, Fibrinogen, Factor VII, Antithrombin III, Protein C, Plasminogen, alpha2-Plasmin Inhibitor, Plasminogen Activator Inhibitor-1, tissue-Plasminogen Activator were functionally evaluated. Antigenic levels of tissue-Plasminogen Activator, Thrombin-Antithrombin complexes and fibrinolytic specific product Bbeta 15-42 were also determined. Compared to the control group diabetic patients displayed significantly higher levels of Fibrinogen (p<0.01), Factor VII (p<0.01), Thrombin-Antithrombin complexes (p<0.01) and Plasminogen Activator Inhibitor-1 activity (p<0.01). Regardless of the normal level of the tissue-Plasminogen Activator-related antigen, diabetic patients had tissue-Plasminogen Activator activity lower than the control group (p<0.05). Coagulation Factor VII and Thrombin-Antithrombin complexes were increased only in the patients with poor metabolic control (p<0.01). Activated Partial Thromboplastin Time, Prothrombin Time, Antithrombin III, Protein C, Plasminogen, alpha2-Plasmin Inhibitor, Bbeta 15-42 fibrin peptide were found to be in the normal range. Fibrinogen correlated positively with fasting blood glucose (p<0.05) and Thrombin-Antithrombin complexes with glycosylated haemoglobin (p<0.05), whereas Factor VII was positively correlated with glycemia (p<0.01) and glycosylated haemoglobin (p<0.05). Higher levels of Fibrinogen were found in patients affected by nephropathy (p<0.005) or neuropathy (p<0.05). These results demonstrate an impairment of the haemostatic balance in diabetic patients, that is a possible hypercoagulable state, which represents an important factor in the pathogenesis of atherosclerotic complications.