Differences in thrombus structure and kinetics in patients with type 2 diabetes mellitus after non ST elevation acute coronary syndrome

Girish N Viswanathan, Sally M Marshall, Karthik Balasubramaniam, Juan J Badimon, Azfar G Zaman, Girish N Viswanathan, Sally M Marshall, Karthik Balasubramaniam, Juan J Badimon, Azfar G Zaman

Abstract

Introduction: Despite optimal secondary prevention therapy following non-ST elevation acute coronary syndrome (NSTE-ACS), recurrent thrombotic events are more frequent in patients with type 2 diabetes mellitus (T2DM).

Materials and methods: This exploratory study was aimed to evaluate quantitative and qualitative aspects of thrombus. In 28 patients with and without T2DM treated with aspirin and clopidogrel we assessed thrombus quantity using an ex-vivo chamber, platelet reactivity, thrombus ultrastructure and thrombus kinetics one week after NSTE-ACS.

Results: T2DM was associated with increased thrombus [14861 (8003 to 30161) vs 8908 (6812 to 11996), μ(2)/mm, median (IQR), p=0.045] and platelet reactivity. In addition, diabetic thrombus showed lower visco-elastic tensile strength [(-0.2(-1.7 to 0.7) vs 1.0(-0.9 to 3.3), p=0.044)] and was more resistant to autolysis [(27.8(11.7 to 70.7) vs 78.8(68.5 to109.6) mm/min, p=0.002)]. On SEM, fibrin fibres in diabetes were thinner, with higher lateral interlinkage and mesh-like organisation. Thrombus quantity correlated inversely with thrombus retraction (r=-0.450 p=0.016) but not with platelet reactivity (r=0.153, p=0.544).

Conclusions: Despite optimal antiplatelet therapy, T2DM patients after NSTE-ACS developed increased thrombus of lower tensile strength and slower retraction. SEM revealed loosely arranged fibrin fibres. Our data showed significant differences in the magnitude as well as structural and mechanistic characteristics of thrombus in patients with T2DM.

Keywords: Antiplatelet therapy; Fibrin structure; Non ST elevation acute coronary syndrome; Thrombus kinetics; Type 2 diabetes mellitus; Whole blood thrombus.

Copyright © 2014. Published by Elsevier Ltd.

Figures

Fig. 1
Fig. 1
Thrombus of patients from Badimon chamber (left and middle column) after staining with modified Mason trichrome. Platelet rich thrombus was stained in pink with the tunica media of the aortic tissue stained in green. The right column shows the representative images of the thrombus under scanning electron microscopy (SEM) at 3.4X103 times magnification. Diabetic thrombus was increased in quantity occupying a larger surface area over the tunica media. The SEM appearance showed loosely woven thrombus with thinner fibrin fibres and mesh like appearance with less twisted arrangement compared to those without diabetes.
Fig. 2
Fig. 2
Correlation graphs between thrombus area and various parameters. Correlation analysis: a. Serum fibrinogen correlated with thrombus area, r = 0.551, p = 0.002. b. Thrombus retraction or autolysis correlated with thrombus area, r = − 0.450. p = 0.016.

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Source: PubMed

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