The levels of Antithrombin III and D-Dimer as indicator of coagulation and fibrinolytic activity in diabetes mellitus

Objective: This study was done in order to investigate coagula¬tion and fibrinolytic activity in patients with diabetes mellitus, in addition to detect the relationship between glycometabolic control and coagulation activity and fibrinolysis in diabetics.
Study design: We determined levels of ATH III, D-dimer, and FDP in 20 healthy subjects and 35 diabetic patients with complications and we examined the correlations between HbAlc and ATH III and D-dimer.
Results: Compared to the control subjects, we found signifi¬cantly increased ATH III and D-dimer levels in patienlts with diabetes mellitus (p<0.0060 and p<0.001, respectively). Clini¬cally relevant increases in FDP levels were observed in diabe¬tics (p<0.050). In patients with good and poor glucose control, we noted significant differences between HbAlc and fasting blood sugar (p<0.000 and p<0.000, respectively). There was a moderate correlation between HbAlc and ATH III in all diabe¬tics (r-0.49, p<0.03); similarly a moderate correlation betwe¬en HbAlc and ATH III was found in patients with poor glucose control (r=0.47, p <0.048). Parallel to this finding, we detected higher ATH III levels in patients with poor glucose control (%112.83±23 versus %100.71±19). No statistically significant relationship was found between HbAlc and D-dimer levels. D- dimer levels in patients with good and poor glucose control were 0.47±0.27 pg/ml and 0.56±0.40 pg/ml, respectively. In patients with complications of diabetes mellitus, a slight corre¬lation was noted between age and D-dimer levels (r-0.4167, p<0.013), whereas there was no correlation between age and ATH III.
Conclusion: In view of our results, we concluded that coagula¬tion and fibrinolytic activity increased in patients with diabetes mellitus, with even more increases in coagulation activity in those with poor glucose control. The relationship between the glycometabolic control and fibrinolytic activity could not be demonstrated using HbAlc levels.

Diabetes mellituslu olgularda koagülasyon ve fibrinolitik aktivite göstergesi olarak Antithrombin III ve D-Dimer düzeyleri

Amaç: Bu çalýþma diabetes mellituslu olgularda koagülasyon ve fibrinolitik aktiviteyi araþtýrmak, ayrýca diabetik olgularda glikometabolik kontrol durumu ile koagülasyon aktivitesi ve fibrinoliz arasýndaki iliþkiyi saptamak için yapýlmýþtýr.
Gereç ve Yöntem: Saðlýklý 20 kontrol olgusunda ve 35 kompli¬kasyonla diabetik olguda Antitrombiýý III (ATI! III), D-dimer, Fibrin yýkým ürünü (FDP) düzeylerini tayin ettik ve Hemoglo¬bin Al e (HhAlc) ile ATI! III ve D-dimer arasýndaki korelasyo¬nu araþtýrdýk.
Bulgular: Çalýþmamýzda DM’lu olgularýn ATM III ve D-Dimer düzeylerini saðlýklý kontrol olgularýndan anlamlý derecede yük¬sek bulduk (p<0.0060, p<().()()l). FDP düzeyi ise DM‘lýý olgu¬larda, saðlýklý kontrol olgularýndan önemlilik sýnýrýnda daha yüksekti (p<0.050). iyi ve kötü kontrollü diabetik olgularda HhAlc ve AKÞ açýsýndan anlamlý bir fark olduðunu saptadýk (p<0.001, p<().00l). Tüm diahetiklerin HbAIc’si ile ATM III‘ii arasýnda orta derecede bir korelasyon (r=0.49, p<0.03), kötü kontrollü gnýlnýn HbAlc’si ile ATH IIFii arasýnda da orta dere¬cede bir korelasyon saptadýk (r=0.47, p=0<048). Buna paralel olarak kötü kontrollü grubun ATH III düzeyini (% 112.83+23), iyi kontrollü grubun ATH-III düzeyinden (%100.71 ±19) daha yüksek saptadýk. HhAlc ile D-dimer arasýnda ise istatistiksel olarak anlamlý bir iliþki saptayamadýk (p>0.5). iyi kontrollü grubun D-dimer düzeyi 0.47±0.27 kötü kontrollü grubun D-di¬mer düzeyi 0.56±0.40 pg/ml olarak bulduk. Komplikasyonla diabetik çalýþma grubumuzda yaþ ile D-dimer arasýnda hafif derecede bir korelasyon vardý (r-0.4167, p<0.013). Yaþ ile ATH III arasýnda ise korelasyon tespit edilmedi.
Sonuçlar: Bu bulgularýmýza dayanarak DM’ lu olgularda koagülasyon aktivitesi ve fibrinolizisin arttýðý kanýsýna vardýk. Kötü metabolik kontrollü DM’lu olgularda koagülasyon aktivitesi dalýa fazla artmaktadýr. Glikometabolik kontrolle fibrinolitik aktivite arasýndaki iliþki ise HhAlc ile gösterilememektedir.