Association Between Plasma Thrombin-Activatable Fibrinolysis Inhibitor Levels and Activated Protein C in Normotensive Type 2 Diabetic Patients

  1. Yutaka Yano, MD,
  2. Esteban C. Gabazza, MD,
  3. Yasuko Hori, MD,
  4. Nagako Kitagawa, MD,
  5. Akira Katsuki, MD,
  6. Rika Araki-Sasaki, MD,
  7. Yasuhiro Sumida, MD and
  8. Yukihiko Adachi, MD
  1. From the Third Department of Internal Medicine, Mie University School of Medicine, Tsu, Mie, Japan

    Hypofibrinolysis is a common finding in patients with diabetes and a risk factor for the occurrence of micro- and macroangiopathy (1–3). Recently, a new potent inhibitor of fibrinolysis, the thrombin-activatable fibrinolysis inhibitor (TAFI) was isolated from human plasma (4). It has been reported that the plasma levels of TAFI are increased in diabetic patients, and it may play an important role in the mechanism of hypofibrinolysis observed in these patients (5).

    Activated protein C (APC) is a serine protease that inhibits thrombin formation by proteolytically inactivating factors Va and VIIIa and by stimulating fibrinolysis (6,7). Thrombin stimulates the conversion of TAFI in its active form. APC may indirectly promote fibrinolysis by inhibiting thrombin generation and by inhibiting the action of plasminogen activator inhibitor-1 (7,8). Both TAFI and APC are regulated by thrombin-thrombmodulin complex on the plasma membrane of endothelium (6). This mechanism appears to be important for controlling the balance between coagulation and fibrinolysis in diabetic patients. In the present study, we investigated the plasma …

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