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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with diabetes mellitus have an increased risk of thrombosis and accelerated atherogenesis. Increased platelet adhesion and aggregation are noted in vitro. This paper reviews known platelet abnormalities found in patients with diabetes mellitus (DM) and examines the pathophysiology associated with these abnormalities. Four general platelet regions or functional units can be involved in aberrant chemistry, structure and/or function. These include (1) the membrane, (2) granules, (3) intermediary metabolism, and (4) other factors and/or platelet responses to various substances. In regard to the abnormalities of the membrane, there is an increased binding of fibrinogen in diabetic rats and increased membrane rigidity. There are increases in glycoprotein Ib and glycoprotein IIb/IIIa. Related to granule function, increased levels of plasma serotonin, histamine and beta thromboglobulin are found. Alterations of intermediary metabolism involving the prostaglandin pathways, arachidonic acid, Vitamin E, and lipids have been reported. Other factors which are not well characterized include abnormalities of stem cell response to growth factors and thrombopoiesis, as noted indirectly through alterations of platelet volumes. It is proposed that these platelet abnormalities result in increased thrombosis and/or an acceleration of the atherosclerotic process in at least some patients with diabetes mellitus.
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PMID:Platelet abnormalities in diabetes mellitus. 843 Oct

Diabetes mellitus is associated with increased risk of short and long-term complications after balloon angioplasty. In patients with multivessel disease, there may be a substantial increase in long-term mortality when percutaneous transluminal coronary angioplasty (PTCA) is preferred over surgery in patients who are amenable to both techniques, which should lead to caution in selecting PTCA as a routine revascularization method for these patients. However, many diabetic patients will still require revascularization with PTCA, either for single-vessel disease or because they are poor surgical candidates. Finally, the impact of recent advances, such as stents and glycoprotein IIb/IIIa inhibitors, on the short and long-term results of percutaneous interventions is still not fully defined and deserves further study.
Diabetes Metab 1999 Jun
PMID:[Coronary revascularization in the diabetic]. 1042 94

Whole blood flow cytometry is a powerful new laboratory technique for assessment of platelet activation and function. Flow cytometry can be used to measure platelet hyperreactivity, circulating activated platelets, leukocyte-platelet aggregates, and procoagulant platelet-derived microparticles in a number of clinical settings, including acute coronary syndromes, angioplasty, cardiopulmonary bypass, acute cerebrovascular ischemia, peripheral vascular disease, diabetes mellitus, preeclampsia, and Alzheimer's disease. Clinical applications of whole blood flow cytometric assays of platelet function in these diseases may include identification of patients who would benefit from additional antiplatelet therapy and prediction of ischemic events. Circulating monocyte-platelet aggregates appear to be a more sensitive marker of in vivo platelet activation than circulating P-selectin-positive platelets. Flow cytometry can also be used in the following clinical settings: monitoring of glycoprotein IIb-IIIa antagonist therapy, diagnosis of inherited deficiencies of platelet surface glycoproteins, diagnosis of storage pool disease, diagnosis of heparin-induced thrombocytopenia, and measurement of the rate of thrombopoiesis.
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PMID:Laboratory markers of platelet activation and their clinical significance. 1046 51

The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.
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PMID:Coronary microembolization--its role in acute coronary syndromes and interventions. 1060 63

Diabetes mellitus is a risk factor for coronarosclerosis and for high mortality after myocardial infarction (MI). The causes of this high mortality are: more extensive and premature coronarosclerosis, more frequent left ventricular dysfunction, worse glycemic control with increased myocardial oxygen consumption, sulfanylurea drugs before and during MI. The results of a multicenter study (DIGAMI) and other studies suggest that a better control of diabetes using intravenous infusion of insulin and glucose, followed by long-term (3 months) intensive insulin therapy subcutaneously, improves long-term prognosis after MI. The relative reduction of mortality at the end of follow-up (3.4 years) is 28%. Thrombolysis reduces mainly mortality in hospital,s period and does not provoke retinal haemorrhages. Aspirin lowers the relative risk of mortality to 0.72. The beta-blockers are less used in diabetic patients because they probably alter diabetic control, lipid profile and "mask" the hypoglycemic symptoms, but the results of the beta-blocker's effect concerning reduction of mortality are convincing. ACE inhibitors and statins also reduce mortality in diabetics with MI, via beneficial influence of endothelial dysfunction. The ATMA study registers reduction of rhythmogenic mortality by 29% with amiodarone in high risk of arrhythmia after MI. The invasive methods of treatment in diabetes are accompanied by higher risk of reobstruction. The attempt to reduce this tendency is realizable with intracoronary stents, glycoprotein IIb/IIIa inhibitors and aggressive early treatment of all other risk factors.
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PMID:[Diabetes mellitus and myocardial infarct--new answers and questions]. 1098 72

Glycoprotein IIb-IIIa receptor inhibitors are the newest anti-platelets drugs currently used in patients with coronary artery disease. We examined mechanisms of their action and different pharmacokinetic and pharmacodynamic characteristics of the four glycoprotein IIb-IIIa antagonists evaluated in randomized, controlled and multicenter trials. We reviewed results of these trials in the settings of percutaneous revascularizations procedures or unstable coronary syndromes. Platelet glycoprotein IIb-IIIa receptor inhibitors reduced incidence of cardiac death and myocardial infarction during the short- and midterm, and benefit was greater in: a) patients undergoing coronary angioplasty with or without stent implantation, particularly in the presence of unstable angina, diabetes or complex and diffuse coronary artery disease; b) as a direct therapy of unstable coronary syndromes, particularly in patients with refractory angina, diabetes and elevated Troponin; more recently they have been used as adjuvant therapy in acute myocardial infarction. Infusion of these drugs was not associated with higher rates of major bleedings.
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PMID:[Platelet glycoprotein IIB-IIIA receptor inhibitors in patients with ischemic heart disease]. 1110 81

Over the past two decades the use of angioplasty has rapidly expanded. As technology and experience have advanced, operators are increasingly faced with two-vessel and three-vessel disease. Coronary artery bypass graft surgery and coronary balloon angioplasty are two possible approaches for patients with multivessel coronary disease. Randomized trials comparing these two different procedures have found no difference in early as well as late mortality between assigned treatment groups. The Bypass Angioplasty Revascularization Investigation (BARI) showed a better long-term outcome with coronary artery bypass in the subgroup of patients with treated diabetes (35% died within 5 years after angioplasty compared with 19% who underwent surgery). Repeat revascularization was more common after angioplasty. Surgery offers more complete revascularization, but morbidity is higher; angioplasty is less invasive but patients are more likely to need another revascularization procedure mainly related to the occurrence of restenosis. Restenosis is often associated with the recurrence of symptoms requiring further revascularization. The use of stents and inhibitors of glycoprotein IIb/IIIa, minimally invasive surgical techniques and all-arterial grafting have the potential to change the scenery of coronary artery revascularization in the next few years.
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PMID:[Coronary angioplasty compared with aortocoronary bypass in patients with multivascular coronary disease]. 1120 7

Percutaneous transluminal coronary angioplasty has proven to be more effective and safer than thrombolytic therapy for the treatment of acute ST elevation myocardial infarction. Coronary intervention decreases early mortality and the incidence of intracerebral hemorrhage when performed by an experienced interventional team in a timely fashion. After failed fibrinolytic therapy for myocardial infarction, percutaneous transluminal coronary angioplasty is indicated for signs of ischemia and is very effective in restoring vessel patency and reducing mortality when used as a rescue procedure. The glycoprotein IIb-IIIa inhibitors improve outcomes in percutaneous transluminal coronary angioplasty, particularly in patients undergoing stent placement. Percutaneous interventional therapy in acute myocardial infarction is particularly beneficial in patients with cardiogenic shock and effective for saphenous vein graft occlusions, patients with diabetes mellitus, and in the elderly. New devices and drugs are currently being tested for acute myocardial infarction and provide hope for even better interventional therapies in the near future.
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PMID:Interventional therapy for acute myocardial infarction. 1148 Mar 79

Diabetes mellitus is an increasing problem in the Western world and is associated with a more advanced state of coronary artery disease than that observed in non-diabetic patients. Diabetes mellitus is a prothrombotic state and poses some unique challenges to the interventional cardiologist. The development of more potent antithrombotic therapies has improved the safety and effectiveness of percutaneous coronary intervention (PCI), particularly in high-risk groups such as diabetic patients. This article summarizes the available data on the use of heparins (unfractionated and low molecular weight), intravenous glycoprotein IIb/IIIa blockers, and oral antiplatelet agents in diabetic patients undergoing PCI.
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PMID:Diabetes and Coronary Intervention: Special Considerations for Antithrombotic Therapy. 1169 99

The Arterial Revascularization Therapy Study (ARTS) and the Stent or Surgery (SoS) trial each randomized patients with multivessel disease to either stenting or bypass surgery. The ARTS showed no difference in mortality between the two strategies, other than in diabetic patients, who fared better with surgery. The SoS trial demonstrated increased mortality in the stent arm, a difference that was not attributable to diabetes. Both trials found that the rates of repeat revascularization were lower with surgery, although the rate with stenting was much lower than had been seen in previous trials of angioplasty. Use of antiplatelet therapy such as intravenous glycoprotein IIb/IIIa inhibitors, especially with their pronounced effects in diabetics and in those with multivessel disease, could potentially equalize the playing field or perhaps even tip the balance in favor of percutaneous intervention.
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PMID:Debate: PCI or CABG for multivessel disease? Viewpoint: No clear winner in an unfair fight. 1180 9


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