24614-Article Text-88446-1-10-20150819 PDF
24614-Article Text-88446-1-10-20150819 PDF
24614-Article Text-88446-1-10-20150819 PDF
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Abstract
Background: Complication of diabetes mellitus (DM) includes coagulation impairment.
Hypercoagulable state in patient with DM may accelerate thromboembolic risk for cardiovascular
disease (CVD). Objective: To assess Prothrombin Time and Activated Partial Thromboplastin Time in
type 2 diabetes mellitus for observing their coagubility status. Methods: This cross sectional study
was conducted in the Department of Physiology, Dhaka Medical College, Dhaka from July 2013 to
June 2014. One hundred male patients with type 2 diabetes mellitus aged 40-60 years and one hundred
age, BMI matched healthy subjects were included as control in this study. Patients were selected from
BIRDEM, Dhaka. Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT) were estimated
by auto analyzer. For statistical analysis unpaired student’t test was used. Results: In this study PT
and APTT were significantly (P<0.001) lower in diabetes mellitus than those of control group.
Conclusion: From this study, it may be concluded that diabetic patients are prone to develop coagulation
impairment.
Key words: Prothromin time, Activated partial thromboplastin time, cardiovascular disease, diabetes
mellitus.
Introduction
in patients with a suspected abnormal the parameters were expressed as mean ± SD.
coagulation. Protrombin time (PT) and APTT are Statistical analysis was done by unpaired
the marker for activation of extrinsic and intrinsic Student’s ‘t’ test. P value < 0.05 was accepted as
pathway respectively 10,11,12. The hyperco- level of significance. Statistical analyses were
aguability state demonstrated by shortened PT performed by using a computer based statistical
and APTT in DM may cause occlusive thrombus program SPSS (Statistical package for social
within a coronary artery13. Therefore shortened science) (version 19).
PT and APTT value is the risk factors for
thromboembolic cardiovascular disease in type Results
2 diabetic patients14. General characteristics are presented in table I.
Subjects of two groups were matched in respect
Therefore, this study aimed to investigate the of age. BMI and BP. Mean prothrombin time (PT)
importance of routine determination PT & APTT and activated partial thromboplastin time (APTT)
in order to assess the coagulation impairment in levels were significantly (P<0.001) lower in
DM to prevent the thromboembolic CVD. patients with diabetes mellitus (Table II). Again,
Methods in this study abnormally shortened PT and APTT
were found in 93% and 91% diabetic patients
This cross sectional study was done in the
respectively (Figure 1 & 2).
department of Physiology in Dhaka Medical
College Dhaka in July 2013 to June 2014. Protocol
of this study was approved by Ethical review Table I: General characteristics of study
committee of Dhaka Medical College and Diabetic subjects(n=200)
Association of Bangladesh. For this study 100
male, age (40-60 years), type 2 diabetic patients Parameters Control Diabetes
with FBG level >7.0 mmol/l and HbA1c > 6.5 % 2 (n=100) (n=100)
and also duration of diabetes >3 years were Age (years) 53.58±4.75 54.72±5.73
selected from BIRDEM, Dhaka. All the study BMI (K/m2) 23.13±2.26 23.15±2.96
subjects were on oral hypoglycemic drugs. One
SBP (mm of Hg) 110±7.02 108±10.20
hundred healthy age BMI matched apparently
DBP(mm of Hg) 65.95±6.34 62.80±4.40
healthy male were considered as control. After
selection of the subjects, the nature, purpose Results are expressed as Mean ±SD. Unpaired
and benefit of the study were explained to each Student’s‘t’ test analyzed statistical significance. n =
Number of subjects. BMI= Body mass index, SBP=
subject in details. They were encouraged for
systolic blood pressure, DBP= Diastolic blood
voluntary participation. Informed written consent pressure.
was taken from the participants. Before taking
blood, detailed family and medical history were
taken. Anthropometric measurement of the Table II: PT and APTT in different groups (n=200)
subjects was done and blood pressure was Parameter Control Diabetes
measured. All the information were recorded in a (n=100) (n=100)
prefixed data schedule. With aseptic precaution,
PT(sec) 11.18±0.41 9.54±0.58***
5 ml of venous blood was collected from ante-
APTT (sec) 31.88±2.20 19.94±0.62***
cubital vein by a disposable plastic syringe from
each subject for estimation of PT and APTT level Results are expressed as Mean±SD. Unpaired Student’s‘t’
test analyzed statistical significance. ***P< 0.001. PT=
by auto analyzer in the laboratory of the Prothrombin time, APTT=Activated partial
Immunology Department of BIRDEM, Dhaka. All thromboplastin time.
Conclusion
From the present study it may be concluded that
patients with diabetes mellitus are more prone to
develop hypercoagulation state. Therefore,
routine examinations of PT & APTT are important
to assess coagulation impairment in DM in order
to prevent thromboembolic CVD in DM.
Acknowledgement
The authors acknowledge Department of
Immunology, BIRDEM, Dhaka, for their
Figure 2: Frequency% distribution of activated cooperation during sample collection and
partial thromboplastin time in diabetes is analysis.
presenting that majority of patients had abnormally
lower APTT. (n = 100) Cut point 24 sec. Conflict of Interest : None
Authors Affiliations
*1. Fayeza Karim, Assistant professor, Department of
Discussion Physiology, Aichi Medical College, Uttara, Dhaka.
In the present study, lower PT level in type 2 Email: drfayeza75@yahoo.com
diabetic male than healthy male is comparable to 2. Quzi Shamima Akter. Professor and Head,
Department of Physiology, Dhaka medical college,
others15,16. But some studies found no significant Dhaka.
changes17,18,19, whereas few investigators found 3. Shamima Jahan, Assistant professor, Department of
prolonged PT in type 2 diabetic subjects20. Physiology, Central Medical College, Comilla.
4. Afruza Khanom, Assistant professor, Department
Again, in the present study, APTT level was
of Physiology, Marks Medical College, Dhaka.
lower in type 2 diabetic male which was similar to 5. Samira Haque, Medical officer, Dhaka medical
others21,22. But, some investigators did not find College, Dhaka.
any significant change of APTT in between type 6. Tania yeasmin, Assistant professor, Department of
2 diabetic male and adult healthy male23,24. Physiology, East West Medical College, Uttara,
Moreover, some researcher found that APTT Dhaka.
level was prolonged in type 2 diabetic subjects25. 7. Tashfia Siddika, Lecturer, Department of Physiology,
Shaheed Suhrawardi Medical College, Dhaka.
It has been suggested that natural anticoagulant 8. Susmita Sinha, Assistant professor, Department of
antithrombin III keeps the natural procoagulant Physiology, Estern Medical College, Comilla.
inhibited. In addition protein C inactivates factors *For correspondence