Failed thrombolysis in diabetes : What is the mechanism ? | Dr.S.Venkatesan MD

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Failed thrombolysis in diabetes : What is the mechanism ?

March 25, 2014 by dr s venkatesan

Diabetes mellitus is a pro-coagulant state,especially so in severe uncontrolled states.(1)
This is mediated by increased levels of plasminogen activator Inhibitor.(PAI 1 and 2
This tilts anti-fibrinolytic forces towards thrombosis.
High PAI-1 is an Independent risk factor for MI in young individuals (3)
During STEMI the success rate of fibrinolysis is significantly lower in diabetic population because high levels of PAI 1 .
The triad of DM,Obesity, Insulin resistance is a powerful predictor of poor response to thrombolysis.

PAI plasminogen activator inhibitor

Source : http://care.diabetesjournals.org/content/35/10/1961/

Reference

1.Mak KH¹, Moliterno DJ, Granger CB, Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.J Am Coll Cardiol. 1997 Jul;30(1):171-9.

2.McGill JB,Schneider DJ,Arfken CL, Factors responsible for impaired fibrinolysis in obese subjects and NIDDM patients. Diabetes 1994;43:104–109

3.Anders Hamsten,, Björn Wiman, Ulf de Faire Increased Plasma Levels of a Rapid Inhibitor of Tissue Plasminogen Activator in Young Survivors of Myocardial Infarction N Engl J Med 1985

4.Masoomi M¹, Samadi S, Sheikhvatan M.Cardiol J. Thrombolytic effect of streptokinase infusion assessed by ST-segment resolution between diabetic and non-diabetic myocardial infarction patients.2012;19(2):168-73.

A comprehensive review about PAI-1 and diabetes

PAI in diabetes failed thrombolysis tpa streptokinase thromolysis resistance

Posted in Cardiology -Mechnisms of disease, cardiology -Therapeutics, Cardiology -unresolved questions, Cardiology lipids /dyslipidemia, Diabetes and Heart | Tagged anti fibrinolytic agents, failed thrombolysis in diabetes, pai 1 and 2, plaminogen activator inhibitor pai, tissue plasminogen activator, tpa | Leave a Comment

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