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Is diabetes a hypercoagulable state? A critical appraisal

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Abstract

Diabetes mellitus (DM), a chronic disease with an increasing incidence and prevalence worldwide, is an established risk factor for arterial cardiovascular, cerebrovascular and peripheral vascular diseases including acute myocardial infarction, stroke and peripheral artery disease. On the other hand, its role as independent risk factor for venous thromboembolism (VTE) and for cardioembolic stroke or systemic embolism (SE) in patients with atrial fibrillation (AF) is more conflicting. Venous and arterial thromboses have traditionally been regarded as separate diseases, but recent studies have documented an association between these vascular complications. Cardiovascular risk factors may contribute to unprovoked VTE, and VTE may be an early symptomatic event in patients at high cardiovascular risk, including diabetic patients. Compelling evidences suggest that DM is associated with a higher risk of development and progression of AF. Furthermore, in AF patients with a coexisting DM the risk of cardioembolic stroke/SE appeared increased. Thus, DM has been included as one of the items of the CHADS2 score and of the subsequent CHA2DS2-VASc score that have been developed to assess the arterial tromboembolic risk of AF patients. Such a high incidence of thromboembolic events observed in these clinical subsets may be attributable to the DM-related prothrombotic state due to a number of changes in primary and secondary hemostasis. Although of potential clinical interest, unfortunately, to date, no study has properly evaluated the effects of drugs used to control blood glucose levels on the risk of venous thromboembolism and arterial cardioembolic events in patients with DM.

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  1. Department of Internal Medicine, ‘S. Croce e Carle’ Hospital, Via Coppino 26, 12100, Cuneo, Italy

    Fulvio Pomero & Luigi Fenoglio

  2. Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, “Federico II” University, Naples, Italy

    Matteo Nicola Dario Di Minno

  3. Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy

    Matteo Nicola Dario Di Minno

  4. Department of Cardiology, Hospital of Tradate, Varese, Italy

    Monica Gianni

  5. Department of Clinical Medicine, Insubria University, Varese, Italy

    Walter Ageno & Francesco Dentali

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  1. Fulvio Pomero
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Pomero, F., Di Minno, M.N.D., Fenoglio, L. et al. Is diabetes a hypercoagulable state? A critical appraisal. Acta Diabetol 52, 1007–1016 (2015). https://doi.org/10.1007/s00592-015-0746-8

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