Impaired endogenous fibrinolysis in diabetes mellitus: mechanisms and therapeutic approaches.

In type II diabetes mellitus the activity of the endogenous fibrinolytic system is reduced secondary to increased plasma activity of the plasminogen activator inhibitor type 1 (PAI-1). Because PAI-1 is considered an independent risk factor for cardiovascular disease, increased PAI-1 activity in diabetes mellitus may partly explain the increased susceptibility to both primary atherosclerosis and restenosis after angioplasty in this disease. The factors contributing to increased PAI-1 expression in diabetes mellitus are reviewed as well as possible therapeutic approaches to normalize increased PAI-1 expression.