PMID- 33602240
OWN - NLM
STAT- MEDLINE
DCOM- 20211005
LR  - 20211005
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 20
IP  - 1
DP  - 2021 Feb 18
TI  - Plasma fibrin clot properties and cardiovascular mortality in patients with type 
      2 diabetes: a long-term follow-up study.
PG  - 47
LID - 10.1186/s12933-021-01230-9 [doi]
LID - 47
AB  - BACKGROUND: Patients with type 2 diabetes mellitus (T2DM) are at high risk of 
      cardiovascular mortality, but the mechanisms behind this remain unclear. 
      Prothrombotic fibrin clot properties have been shown in T2DM and cardiovascular 
      disease. We hypothesized that formation of denser clots, which are resistant to 
      fibrinolysis, has a negative impact on cardiovascular mortality in T2DM. METHODS: 
      We studied 133 T2DM patients aged 43-83 years. Plasma fibrin clot turbidity, 
      permeation, compaction, and efficiency of clot lysis using 3 assays including the 
      determination of maximum concentration (D-D(max)) and rate of increase in D-dimer 
      concentration (D-D(rate)) released during tissue plasminogen activator-induced 
      degradation, were evaluated at the time of enrollment, along with thrombin 
      generation and fibrinolytic proteins. During a median follow-up period of 
      72 months, cardiovascular mortality was recorded. RESULTS: Cardiovascular deaths 
      (n = 16, 12%) occurred more frequently in patients with increased D-D(max) 
      (> 4.26 mg/l, hazard ratio [HR] 5.43, 95% confidence interval [CI] 1.99-14.79), 
      or decreased D-D(rate) (< 0.07 mg/l/min, HR 2.97, 95% CI 1.07-8.23), or increased 
      peak thrombin (> 283.5 nM, HR 5.65, 95% CI 2.07-15.51). These predictors had an 
      even more potent impact on cardiovascular mortality in patients with prior 
      cardiovascular disease (64.7%) and with corresponding risks as follows: HR 6.18, 
      95% CI 2.02-18.96; HR 8.98, 95% CI 2.99-26.96; and HR 5.35, 95% CI 1.62-17.72, 
      respectively. Other investigated fibrin variables and fibrinolytic proteins did 
      not associate with cardiovascular mortality. In multivariable analysis, 
      cardiovascular mortality was predicted by D-D(max) > 4.26 mg/l, age > 65 years, 
      prior cardiovascular disease, and C-reactive protein > 3 mg/l. CONCLUSIONS: This 
      study is the first to show that formation of denser fibrin clots resistant to 
      fibrinolysis could be a risk factor for long-term cardiovascular mortality in 
      T2DM.
FAU - Bryk, Agata Hanna
AU  - Bryk AH
AUID- ORCID: 0000-0001-6079-2263
AD  - Department of Endocrinology, Jagiellonian University Medical College, Krakow, 
      Poland.
AD  - John Paul II Hospital, Krakow, Poland.
FAU - Konieczynska, Malgorzata
AU  - Konieczynska M
AD  - John Paul II Hospital, Krakow, Poland.
FAU - Polak, Maciej
AU  - Polak M
AD  - Department of Epidemiology and Population Studies, Institute of Public Health, 
      Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, 
      Poland.
FAU - Plicner, Dariusz
AU  - Plicner D
AD  - Unit of Experimental Cardiology and Cardiac Surgery, Faculty of Medicine and 
      Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland.
FAU - Bochenek, Maciej
AU  - Bochenek M
AD  - Clinic of Cardiac Transplantation and Mechanical Circulatory Support, Department 
      of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
FAU - Undas, Anetta
AU  - Undas A
AD  - John Paul II Hospital, Krakow, Poland. mmundas@cyf-kr.edu.pl.
AD  - Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka 
      St., 31-202, Krakow, Poland. mmundas@cyf-kr.edu.pl.
LA  - eng
PT  - Journal Article
DEP - 20210218
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Fibrin Fibrinogen Degradation Products)
RN  - 0 (fibrin fragment D)
RN  - 9001-31-4 (Fibrin)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Blood Coagulation
MH  - Cardiovascular Diseases/*blood/diagnosis/mortality
MH  - Diabetes Mellitus, Type 2/*blood/diagnosis/mortality
MH  - Female
MH  - Fibrin/*metabolism
MH  - Fibrin Fibrinogen Degradation Products/metabolism
MH  - Fibrinolysis
MH  - Heart Disease Risk Factors
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Risk Assessment
MH  - Time Factors
PMC - PMC7893920
OTO - NOTNLM
OT  - Cardiovascular mortality
OT  - D-dimer
OT  - Fibrin clot
OT  - Type 2 diabetes
COIS- The authors declare that they have no competing interests.
EDAT- 2021/02/20 06:00
MHDA- 2021/10/06 06:00
PMCR- 2021/02/18
CRDT- 2021/02/19 05:41
PHST- 2020/10/24 00:00 [received]
PHST- 2021/01/29 00:00 [accepted]
PHST- 2021/02/19 05:41 [entrez]
PHST- 2021/02/20 06:00 [pubmed]
PHST- 2021/10/06 06:00 [medline]
PHST- 2021/02/18 00:00 [pmc-release]
AID - 10.1186/s12933-021-01230-9 [pii]
AID - 1230 [pii]
AID - 10.1186/s12933-021-01230-9 [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2021 Feb 18;20(1):47. doi: 10.1186/s12933-021-01230-9.