Abstract 597: Plasma Fibrin Clot Strength in Patients With Diabetes Mellitus Measured by Thrombelastography

Background: Patients with diabetes mellitus (DM) exhibit increased risk of recurrent myocardial infarction. Maximal clot strength measured by thrombelastography (TEG) in whole blood is a risk factor for recurrent ischemic events. We hypothesized that diabetic subjects exhibit increased fibrin clot strength in platelet poor plasma and that extent of glycemic control correlates with maximal fibrin clot strength. Methods: Platelet poor plasma samples were obtained from subjects with known or suspected coronary artery disease prior to cardiac catheterization (n=354). Kaolin activated TEG was performed in citrate plasma. Time to fibrin formation (R), clot formation time (K), and maximal fibrin clot strength (MA) measured. Hemoglobin (Hgb) A1C and daily administered insulin doses were recorded. Results: Fibrin MA was increased among subjects with DM as compared to non-DM (37.0 ± 8 mm vs. 34.1 ± 8; p<0.001). HgbA1c was significantly correlated with MA (r=0.213; p=0.002). There was no significant correlation between daily insulin dose and MA among patients with insulin dependent DM (r=0.04; p=0.8). In multivariable regression analysis, DM remained significantly associated with plasma MA after adjustment for other clinical variables (p=0.01). Conclusions: DM is associated with elevated fibrin clot strength (MA). In addition, increased MA appears to be associated with worse glycemic control as defined by HgbA1C. Our results support that patients with DM, in particular those subjects with poor control, demonstrate more stable fibrin generation than subjects without DM. This may in part contribute to the increased ischemic risk in patients with poorly controlled DM.