Antithrombin III Protein C and Protein S

Antithrombin III inhibits the activity of multiple serine proteases of the coagulation pathway. Levels of antithrombin III have been shown to be diminished in patients with diabetes (38). Protein C and Protein S levels have been known to be decreased in patients with diabetes, predisposing them to thrombosis (2, 3).

Lp(a) is a modified form of LDL in which a large glycoprotein, apolipoprotein(a), is covalently bound to apo B by a disulfide bridge. It is structurally similar to human plasminogen. Lp(a) competes with plasminogen and tissue-type plasminogen activator for fibrin binding. As a consequence, Lp(a) inhibits fibrinolysis and acts as a procoagulant (33). Elevated levels of Lp(a) have been associated with the CMS (Table 2).

Table 2

Coagulation Abnormalities in Diabetes [Source: (2)]

Increased plasma levels of factor VII, factor VIII, and von Willebrand factor Increased fibrinogen levels Increased lipoprotein(a) levels

Increased fibrinogen and plasminogen activator inhibitor-1 levels Elevated thrombin-antithrombin complexes Decreased antithrombin II, protein C, and protein S Decreased plasminogen activators and fibrinolytic activity Increased endothelial expression of adhesion molecules Increased adhesion of platelets and leukocytes to the endothelium Increased lipoprotein glycation

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