Li Xiaoling, Weber Nina C, Cohn Danny M, Hollmann Markus W, DeVries J Hans, Hermanides Jeroen, Preckel Benedikt
Department of Anesthesiology, Amsterdam UMC location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Department of Vascular Medicine, Amsterdam UMC location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Med. 2021 May 29;10(11):2419. doi: 10.3390/jcm10112419.
In patients with diabetes, metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet hypersensitivity, coagulation disorders and hypofibrinolysis. Hyperglycemia and insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulatory and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with diabetes. Other coexisting factors like hypoglycemia, obesity and dyslipidemia also contribute to coagulation disorders in patients with diabetes. Management of the prothrombotic state includes antiplatelet and anticoagulation therapies for diabetes patients with either a history of cardiovascular disease or prone to a higher risk of thrombus generation, but current guidelines lack recommendations on the optimal antithrombotic treatment for these patients. Metabolic optimizations like glucose control, lipid-lowering, and weight loss also improve coagulation disorders of diabetes patients. Intriguing, glucose-lowering drugs, especially cardiovascular beneficial agents, such as glucagon-like peptide-1 receptor agonists and sodium glucose co-transporter inhibitors, have been shown to exert direct anticoagulation effects in patients with diabetes. This review focuses on the most recent progress in the development and management of diabetes related prothrombotic state.
在糖尿病患者中，代谢紊乱会破坏凝血和纤溶的生理平衡，导致以血小板超敏反应、凝血障碍和纤溶功能减退为特征的血栓前状态。高血糖和胰岛素抵抗会导致血小板数量和活性的改变，以及凝血和纤溶因子的质和/或量的改变，从而在糖尿病患者中形成抗纤溶的血栓。低血糖、肥胖和血脂异常等其他并存因素也会导致糖尿病患者出现凝血障碍。对于有心血管疾病史或血栓形成风险较高的糖尿病患者，血栓前状态的管理包括抗血小板和抗凝治疗，但目前的指南缺乏针对这些患者最佳抗栓治疗的建议。血糖控制、降脂和减肥等代谢优化措施也能改善糖尿病患者的凝血障碍。有趣的是，降糖药物，尤其是对心血管有益的药物，如胰高血糖素样肽-1受体激动剂和钠-葡萄糖协同转运蛋白抑制剂，已被证明在糖尿病患者中具有直接的抗凝作用。本综述重点关注糖尿病相关血栓前状态的发展和管理方面的最新进展。
