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Comparison of antithrombin III levels in type 2 diabetes mellitus patients with and without ulcers at Haji Adam Malik Hospital Medan Indonesia from may to july 2017



Abstract

Introduction: People with diabetes mellitus (DM) have an increased risk for thrombosis compared with non-diabetic patients. Several studies showed contradicting in data on levels of antithrombin III (AT-III) in people with type 2 DM and diabetic ulcers.

Methods: This is a descriptive and analytical cross-sectional study on AT-III concentration of patients with type 2 DM with and without foot ulcers. A total of 40 subjects are divided equally into the control group, which consist of type 2 DM patients without foot ulcers, and the case group of type 2 DM patients with a diabetic foot ulcer based on the Wagner criteria. Blood samples are then taken after 8 to 10 hours of fasting to check for AT-III concentration and hemostasis examination including platelet count, prothrombin time (PT),  activated partial thromboplastin time (aPTT), thrombin time (TT), fibrinogen levels, and D-dimers.

Results: The mean AT-III level of diabetic foot ulcers group was 216.02 ± 71.23 pg/mL, which was lower than the mean AT-III level of the group without diabetic foot ulcers, i.e. 243.05 ± 48.05 pg/mL. The mean AT-III concentration in the diabetic foot ulcers group with hypercoagulation state was 221.52 ± 64.25 pg/mL, which was slightly higher than the mean AT-III concentration of the diabetic foot ulcers group with hypocoagulation state of 203.18 ± 90.92 pg/mL.

Conclusion: No statistically significant difference was found in the levels of AT-III between the diabetic foot ulcers group and the non-diabetic foot ulcers group (p> 0.05). There was no statistically significant difference in AT-III levels of diabetic foot ulcers with hypercoagulation compared with no diabetic foot ulcers with hypocoagulation and no statistically significant relationship between grade diabetic foot ulcers and AT-III concentration.

Keywords: Antithrombin III AT-III type-2 diabetes mellitus diabetic foot diabetic ulcer

References

  1. Suharti C. Dasar Dasar Hemostasis. In: Setiati, S, Alwi I, Sudoyo A, Simadibrata K, Setyohadi B, Syam AF (editor). Buku Ajar Ilmu Penyakit Dalam. Ed ke-6. Interna publishing, Jakarta. 2014; pg. 2751-9.
  2. Oesman F, Setiabudy RD. Fisiologi Hemostasis dan Fibrinolisis. In: Setiabudy RD (editor). Hemostasis dan Trombosis. Ed ke-3. Balai penerbit FKUI, Jakarta; 2007.
  3. Setiabudy RD. Patofisiologi Trombosis. In: Setiabudy RD (editor). Hemostasis dan thrombosis. Ed ke-3. Balai penerbit FKUI; Jakarta: 2007.
  4. Carr ME. Diabetes mellitus. Journal of Diabetes and its Complications, 2001. 15(1), pp. 44–54.
  5. Benyamin AF, Gustaviani R, Gangguan Hemostasis Pada Diabetes Melitus. Didalam: Setiati S, Alwi I, Sudoyo A, Simadibrata K, Setyohadi B, Syam AF (editor). Buku Ajar Ilmu Penyakit Dalam. Ed ke- 6. Interna publishing, Jakarta, 2014.
  6. Kalani M, et al. Effect of Dalteparin on Healing of Chronic Foot Ulcers in Diabetic Patients With Peripheral Arterial Occlusive Disease: A prospective, randomized, double-blind, placebo-controlled study. Diabetes Care, 2003. 26(9), pp. 2575–80.
  7. Kalani M, et al. Beneficial effects of dalteparin on haemostatic function and local tissue oxygenation in patients with diabetes, severe vascular disease and foot ulcers. Thrombosis Research, 2007. 120(5), pp. 653–61.
  8. Whitmont K, et al. Low Circulating Protein C Levels Are Associated with Lower Leg Ulcers in Patients with Diabetes. BioMed Research International, 2013. pp.1–4.
  9. Onbasi K, et al. Diabetes Melitus and the Natural Anticoagulants. Turkish Journal of Endocrinology and Metabolism, 1999. 2, pp. 53-63.
  10. Stegenga ME, et al. Hyperglycemia Stimulates Coagulation, Whereas Hyperinsulinemia Impairs Fibrinolysis in Healthy Humans. Diabetes, 2006. 55(6), pp.1807–1812.
  11. Meigs JB, et al. Hyperinsulinemia, Hyperglycemia, and Impaired Hemostasis. Jama, 2000. 283(2), p.221.
  12. Saleh S. Gangguan peredaran cairan tubuh, elektrolit dan darah. Didalam: Himawan S., editor. Kumpulan kuliah patologi. Bagian Patologi anatomi, Jakarta, 1994.
  13. Suhartono, Gatot D. Hiperkoagulasi pada penderita ulkus kaki diabetika. [TESIS]. Medan: Departemen Ilmu Penyakit Dalam, 2008.
  14. Mammen, E., 1998. Antithrombin: Its Physiological Importance and Role in DIC. Seminars in Thrombosis and Hemostasis, 24(01), pp.19–25.
  15. Bryan A, Angela S. 2015. Antithrombin Deficiency [Internet]. Cited [16 Oct 2016]. Available from: http://emedicine.medscape.com/article/198573-overview.
  16. Hamulu F, et al. The Level of Antithrombin III (AT III) in Turkish Diabetics. Turkish Journal of Endocrinology and Metabolism, 1998. 4, pp.209-212.
  17. Meade T, et al. Antithrombin III and arterial disease. The Lancet, 338(8771), 1991. pp. 850–1.
  18. Yekta Z, Pourali, Ghasemi-Rad M. Comparison of demographic and clinical characteristics influencing health-related quality of life in patients with diabetic foot ulcers and those without foot ulcers. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2011. p.393.
  19. Shailesh K, et al. Prevalence of Diabetic Foot Ulcer and Associated Risk Factors in Diabetic Patient From North India. The Journal of Diabetic Foot Complications, 2012. 4(3), pp.83-91.
  20. Al-Rubeaan K, et al. Diabetic Foot Complications and Their Risk Factors from a Large Retrospective Cohort Study. Plos One, 10(5). 2015.
  21. Wright JA, Oddy MJ, Richards T. Presence and Characterisation of Anaemia in Diabetic Foot Ulceration. Anemia, 2014. pp. 1–8.
  22. Salman IN, Wadood SA. Abualkasem BA. Low Hemoglobin Levels in Infected Diabetic Foot Ulcer. IOSR Journal of Pharmacy and Biological Sciences, 2017. 12(01), pp.05–09.
  23. Li XH, et al. Fibrinogen: A Marker in Predicting Diabetic Foot Ulcer Severity. Journal of Diabetes Research, 2016. pp.1–5.
  24. Madan R, et al. Coagulation Profile in Diabetes and its Association with Diabetic Microvascular Complications. J Assoc Physicians India, 2010. 58, pp.481–4.
  25. Monnier L, Follea G, Mirouze J. Antithrombin III Deficiency in Diabetes Mellitus:Influence on Vascular Degenerative Complications. Hormone and Metabolic Research, 1978. 10(06), pp.470–3.
  26. Ceriello A, et al. The Role of Hyperglycaemia-induced Alterations of Antithrombin III and Factor X Activation in the Thrombin Hyperactivity of Diabetes Mellitus. Diabetic Medicine, 1990. 7(4), pp.343–8
  27. Godoy JMPD, Torres CAA, Braile DM. Prevalence of antithrombin deficiency in patients with chronic leg ulcer. Blood Coagulation & Fibrinolysis, 2001. 12(7), pp.593–5.
  28. Bolaman Z, et al. The Changes of Coagulation Parameters and Microvascular Complications in Diabetes Mellitus. The Endocrinologist, 2007. 17(4), pp.196–199.
  29. Junbin H, et al. Variations and clinical significance of coagulation and fibrinolysis parameters in patients with diabetes mellitus. Journal of Tongji Medical University, 1998. 18(4), pp.233–5.
  30. Erem C, et al. Coagulation and Fibrinolysis Parameters in Type 2 Diabetic Patients with and without Diabetic Vascular Complications. Medical Principles and Practice, 2004. 14(1), pp.22–30.
  31. Kulwas A, et al. Tissue plasminogen activator (t-PA) and plasminogen activator inhibitor type 1 (PAI-1) in diabetic foot syndrome. Advances in Medical Sciences, 2017. 62(1), pp.87–91.
  32. Davi G, et al. Thrombin-Antithrombin III Complexes in Type 2 Diabetes Mellitus. Journal of Diabetes and its Complications, 1992. (4), pp7-11.

How to Cite

Zulfahmi, Z., Mardia, A. I., Handayani, S., Syafril, S., & Gatot, D. (2019). Comparison of antithrombin III levels in type 2 diabetes mellitus patients with and without ulcers at Haji Adam Malik Hospital Medan Indonesia from may to july 2017. Bali Medical Journal, 8(2), 646–651. https://doi.org/10.15562/bmj.v8i2.914
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Zulfahmi Zulfahmi
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Andri I Mardia
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Savita Handayani
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Santi Syafril
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Dairion Gatot
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