The Changes of Coagulation Parameters and Microvascular Complications in Diabetes Mellitus

Background: Changes in the coagulation cascade have been implicated in the pathogenesis of the vascular complications of diabetes mellitus (DM). The objective of this study was to evaluate several coagulation parameters in diabetic patients with microvascular complications. Materials and Methods: One hundred thirty-two patients with DM type 2 were divided to 3 groups: patients without microvascular complications (group 1), patients with retinopathy or neuropathy (group 2), and patients with nephropathy (group 3). Thirty healthy persons constituted a control group. Prothrombin time, partial thromboplastin time, fibrinogen, von Willebrand factor (vWf), antithrombin III, protein C, protein S, and D-dimer levels were examined. Results: While partial thromboplastin time was shorter in patients without microvascular complications than controls (P < 0.05), prothrombin time was shorter in patients with nephropathy compared with control subjects (P < 0.001). Fibrinogen and vWf levels were increased in all groups compared with control subjects (P < 0.001). vWf levels in patients with retinopathy and or neuropathy were higher than in patients without microvascular complications (P < 0.001). D-dimer levels were increased in patients with nephropathy compared with control subjects (P < 0.001). The levels of coagulation inhibitors including protein C, protein S, and antithrombin III levels in all patients were lower than in control subjects (P < 0.001). Conclusion: We detected a tendency to hypercoagulability in DM. Coagulation inhibitors were decreased in all diabetic patients. Fibrinolytic activity was increased in diabetic patients with nephropathy, and vWf levels were increased in patients with diabetic retinopathy and or neuropathy. These changes in the coagulation pathways may play a role in the development of microvascular complications in DM.