In patients with diabetes, metabolic disorders disturb the physiological balance of coagulation and fibrinolysis, leading to a prothrombotic state characterized by platelet
hypersensitivity, coagulation disorders and hypofibrinolysis.
Hyperglycemia and
insulin resistance cause changes in platelet number and activation, as well as qualitative and/or quantitative modifications of coagulatory and fibrinolytic factors, resulting in the formation of fibrinolysis-resistant clots in patients with diabetes. Other coexisting factors like
hypoglycemia,
obesity and
dyslipidemia also contribute to coagulation disorders in patients with diabetes. Management of the prothrombotic state includes antiplatelet and anticoagulation
therapies for diabetes patients with either a history of
cardiovascular disease or prone to a higher risk of
thrombus generation, but current guidelines lack recommendations on the optimal antithrombotic treatment for these patients. Metabolic optimizations like
glucose control,
lipid-lowering, and
weight loss also improve coagulation disorders of diabetes patients. Intriguing,
glucose-lowering drugs, especially cardiovascular beneficial agents, such as
glucagon-like peptide-1 receptor agonists and
sodium glucose co-transporter inhibitors, have been shown to exert direct anticoagulation effects in patients with diabetes. This review focuses on the most recent progress in the development and management of diabetes related prothrombotic state.