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TableĀ 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