Abstract 17675: Higher Thrombus Burden and Impaired Clot Kinetics in Patients with Type 2 Diabetes Mellitus following Non ST-Elevation Acute Coronary Syndrome
Introduction: Patients with type 2 diabetes mellitus (T2DM) have increased thrombotic events following non- ST elevation acute coronary syndrome (NSTE-ACS) despite optimal antithrombotic therapy. We aimed to evaluate mechanistic properties of thrombus formation in these individuals.
Methods: We studied 30 T2DM and 30 non-diabetic patients one week after troponin positive NSTE-ACS. All patients were treated as per current AHA/ESC guidelines and had 300mg loading dose followed by 75 mg maintenance dose of both aspirin and clopidogrel. All patients underwent ex-vivo Badimon clotting chamber study to assess thrombus burden. A sub-group of 23 patients (13 T2DM and 10 non-diabetic) underwent thromboelastography(TEG®) to assess clot kinetics.
Results: T2DM patients had similar baseline cardiovascular risk factor profile except higher HbA1c, [mean (SD), 7.6 % (1.6) v 5.6 %(0.3), p<0.001,] and lower LDL cholesterol [mean(SD) 1.5(0.6) v 2.0(0.7) mmol/l, p=0.005]. Higher thrombus burden was seen in T2DM, area of thrombus: mean (SD) [16824.0(3619.1) v 14413.9(4648.5) μ2/mm, P=0.029], 95% CI 254.3–4565.8. Clot kinetics were significantly different in T2DM. T2DM patients had lower visco-elastic tensile strength of the thrombus, clot index, median (range) 0.4 (−3.3 to 4.2) v 1.6 (−1.5 to 5.4), p=0.026 and less clot retraction V-curve clot lysis, median (range) 27.7 (3.8–83.4) v 73.7 (55–191) mm/min, p=0.017.
Conclusions: In patients with T2DM thrombus was i) increased in quantity, ii) weaker in tensile strength and iii) more resistant to clot retraction (auto-lysis) despite current post NSTE-ACS secondary prevention therapy . Our findings may explain the reduced benefits in diabetic patients of existent antiplatelet therapy and support the need for individualised and more potent anti-thrombotic therapy.
- © 2010 by American Heart Association, Inc.