ARTERIAL THROMBOSIS AND ATHEROSCLEROSIS IN DIABETES

Enhancement of multiple thrombogenic constituents, including platelet activation, hypercoagulation, impaired fibrinolysis, abnormal hemorheo logy, and altered endothelial metabolism, has been found in diabetes, Specific thrombogenic abnormalities in diabetes and their association with the development of macrovascular disease are reviewed in this art icle, Proposed pathogenetic mechanisms underlying the prothrombotic te ndency in diabetes include not only changes of insulin, glucose, and l ipoprotein metabolism, but also modified immune and inflammatory defen ses and genetic variability, Many hemostatic disorders in diabetes, ho wever, are also known to be a consequence of established vascular lesi ons, Standard diabetes management can help to correct the prothromboti c imbalance in diabetes, although additional antithrombotic therapy ma y be necessary, Meta-analysis of antiplatelet trials supports the use of low-dose aspirin in all diabetic individuals with high vascular ris k. New clinical trials may justify other approaches, such as using new antiplatelet agents, specific anticoagulants, antioxidants, drugs to lower fibrinogen and reduce overproduction of plasminogen activator in hibitors, or agents that stimulate endothelium-associated fibrinolysis . Future research may identify different candidate genes for atheroscl erosis within the hemostatic system and expand evolving vascular gene therapy.