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Background   Patients with diabetes mellitus (DM) exhibit increased risk of recurrent myocardial infarction. Maximal clot strength measured by thrombelastography (TEG) is a risk factor for recurrent ischemic events. We hypothesized that diabetic subjects exhibit increased fibrin clot strength in platelet-poor plasma and that glycemic control correlates with maximal fibrin clot strength.Methods   We collected plasma samples from subjects with known or suspected coronary artery disease undergoing cardiac catheterization ( n  = 354). We measured kaolin-activated TEG in platelet-poor citrate plasma. Time to fibrin formation (R), clot formation time (K), and maximal fibrin clot strength (MA) were recorded.Results   Plasma fibrin MA was increased among subjects with DM ( n  = 152) as compared to non-DM ( n  = 202) (37.0 ± 8 versus 34.1 ± 8 mm;  p  < 0.001). Hemoglobin A1c (HbA1c) ( ρ  = 0.22;  p  = 0.001) and fibrinogen ( ρ  = 0.29;  p  < 0.001) correlated with fibrin MA. In multivariable regression analysis, DM remained significantly associated with plasma MA after adjustment for fibrinogen level ( p  = 0.003).Conclusions   Subjects with diabetes mellitus exhibit increased maximal fibrin clot strength measured by TEG in platelet-poor plasma.

Fibrin Clot Strength in Patients with Diabetes Mellitus Measured by Thrombelastography