title: Differences in thrombus structure and kinetics in patients with type 2 diabetes mellitus after non ST elevation acute coronary syndrome.
abstract: BACKGROUND
  Despite optimal secondary prevention therapy following non-ST elevation acute coronary syndrome (NSTE-ACS), recurrent thrombotic events are more frequent in patients with type 2 diabetes mellitus (T2DM).
  
  
  METHODS
  This exploratory study was aimed to evaluate quantitative and qualitative aspects of thrombus. In 28 patients with and without T2DM treated with aspirin and clopidogrel we assessed thrombus quantity using an ex-vivo chamber, platelet reactivity, thrombus ultrastructure and thrombus kinetics one week after NSTE-ACS.
  
  
  RESULTS
  T2DM was associated with increased thrombus [14861 (8003 to 30161) vs 8908 (6812 to 11996), μ(2)/mm, median (IQR), p=0.045] and platelet reactivity. In addition, diabetic thrombus showed lower visco-elastic tensile strength [(-0.2(-1.7 to 0.7) vs 1.0(-0.9 to 3.3), p=0.044)] and was more resistant to autolysis [(27.8(11.7 to 70.7) vs 78.8(68.5 to109.6) mm/min, p=0.002)]. On SEM, fibrin fibres in diabetes were thinner, with higher lateral interlinkage and mesh-like organisation. Thrombus quantity correlated inversely with thrombus retraction (r=-0.450 p=0.016) but not with platelet reactivity (r=0.153, p=0.544).
  
  
  CONCLUSIONS
  Despite optimal antiplatelet therapy, T2DM patients after NSTE-ACS developed increased thrombus of lower tensile strength and slower retraction. SEM revealed loosely arranged fibrin fibres. Our data showed significant differences in the magnitude as well as structural and mechanistic characteristics of thrombus in patients with T2DM.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: Girish.viswanathan@newcastle.ac.uk.
authors.forename: Girish N
authors.initials: GN
authors.lastname: Viswanathan
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: s.m.marshall@newcastle.ac.uk.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Marshall
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Electronic address: karthik.balasubramaniam@newcastle.ac.uk.
authors.forename: Karthik
authors.initials: K
authors.lastname: Balasubramaniam
authors.affiliation: The Mount Sinai School of Medicine, NY, USA. Electronic address: juan.badimon@mssm.edu.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Badimon
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Freeman Hospital, Newcastle upon Tyne, UK. Electronic address: Azfar.zaman@nuth.nhs.uk.
authors.forename: Azfar G
authors.initials: AG
authors.lastname: Zaman
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D013927:Thrombosis / Q000097:blood* / Q000473:pathology*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Antiplatelet therapy; Fibrin structure; Non ST elevation acute coronary syndrome; Thrombus kinetics; Type 2 diabetes mellitus; Whole blood thrombus