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Curr Diab Rep. 2007 Jun;7(3):223-7.

Effects of hyperglycemia and hyperinsulinemia on the tissue factor pathway of blood coagulation.

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Division of Endocrinology/Diabetes/Metabolism and the Clinical Research Center, Temple University Hospital, 3401 N. Broad Street, Philadelphia, PA 19140, USA.


Tissue factor (TF) is the primary initiator of blood coagulation. Circulating TF procoagulant activity (TF-PCA) is associated with blood cells and microparticles and is elevated in patients with type 2 diabetes mellitus. Combined hyperinsulinemia and hyperglycemia and to a lesser degree selective hyperinsulinemia for 24 hours in healthy volunteers increased circulating TF-PCA, monocyte TF surface expression and mRNA, plasma thrombin generation, and coagulation factors VII and VIII activities, suggesting that the coagulation system had been activated. In addition, platelet CD40L and platelet-monocyte aggregates increased, indicating platelet activation. Somatostatin abolished these changes. We conclude that hyperinsulinemia, but particularly the combination of hyperinsulinemia and hyperglycemia, creates a prothrombotic state and may, in addition, be proinflammatory and proatherogenic by virtue of the actions of CD40L and TF.

[Indexed for MEDLINE]

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