Format

Send to

Choose Destination
See comment in PubMed Commons below
Thromb Res. 2014 May;133(5):880-5. doi: 10.1016/j.thromres.2014.01.033. Epub 2014 Feb 1.

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

Author information

1
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: Girish.viswanathan@newcastle.ac.uk.
2
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: s.m.marshall@newcastle.ac.uk.
3
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: karthik.balasubramaniam@newcastle.ac.uk.
4
The Mount Sinai School of Medicine, NY, USA. Electronic address: juan.badimon@mssm.edu.
5
Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: Azfar.zaman@nuth.nhs.uk.

Abstract

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), μ(2)/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.

KEYWORDS:

Antiplatelet therapy; Fibrin structure; Non ST elevation acute coronary syndrome; Thrombus kinetics; Type 2 diabetes mellitus; Whole blood thrombus

PMID:
24582462
PMCID:
PMC4018991
DOI:
10.1016/j.thromres.2014.01.033
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center