Table 1 Current therapeutic interventions to reduce thrombosis risk in diabetes with their main limitations
From: Hypofibrinolysis in diabetes: a therapeutic target for the reduction of cardiovascular risk
Risk factor | Cause | Current therapeutic intervention | Pitfalls of current therapeutic strategy |
|---|---|---|---|
Premature atherosclerosis | Metabolic abnormalities Inflammatory changes resulting in endothelial dysfunction | Treated in the acute stage with revascularisation Control of blood pressure, lipid and glucose levels in the long term | Mainly preventative Limited ability to reverse vascular pathological changes |
Prothrombotic environment | Enhanced platelet activity Altered levels of coagulation factors | Dual antiplatelet therapy (DAT) for 1 year following an acute coronary event Lifelong platelet monotherapy after 1 year | Aspirin resistance in individuals with diabetes Bleeding risk No targeting of the fibrin network |
Hypofibrinolysis | Formation of more compact clots Impaired fibrinolytic system | Not usually targeted Agents that modulate the coagulation cascade, which are likely to affect fibrinolysis, are used in the presence of cardiac arrhythmias, valvular heart disease or venous thrombosis | Adding an agent that targets the fibrin network, particularly on a background of DAT, increases the risk of bleeding complications |