Effect of metformin on fibrinolysis in type 2 diabetes mellitus: an explorative study

Type 2 diabetes mellitus (T2DM) is associated with a high incidence of vascular disease which can cause significant morbidity and mortality. The risk of cardiovascular mortality in T2DM patients is observed to be more compared to the age-matched subjects. This is attributed to depression of the fibrinolytic system which maintains patency of blood vessels. Endogenous inhibitors such as plasminogen activator inhibitor-1 (PAI-1) inhibit the activation of plasminogen and thus prevent the degradation of fibrinogen. In T2DM there is increased levels of PAI-1. Such a state of altered fibrinolysis is attributed to insulin resistance. A previous study done at our institute demonstrated higher euglobulin lysis time (ELT) in T2DM patients than controls, suggesting altered fibrinolytic activity in the former group. D-dimer is a degradation product of fibrin. Its presence indicates a state of hypercoagulability. In a study by Nwose et al rise in D-dimer levels were observed in diabetics, especially with cardiovascular complications as compared to controls indicating D-dimer could be a useful marker for predicting the complications in T2DM.