Endothelial and platelet markers in diabetes mellitus type 2

Diabetes mellitus(DM) is an extremely common disorder which carries a risk of vascular impairment.DM type 2(DM2) can be characterized by the dysfunction of haemostasis manifesting by stimulated coagulation process,disorder of platelet function and decreased fibrinolytic activity.These all are the reasons why DM2 is the most common acquired thrombophilia.Endothelial dysfunction along with platelet hyperactivity are unquestionably involved in the hyperactivation of platelets and clotting factors in DM.As a natural consequence of continuous investigation,many markers of endothelial dysfunction and diabetic thrombocytopathy have been identified and considered for implementation in clinical practice.Endothelial function can be assessed by the evaluation of endothelial markers,circulating molecules synthesised in various amounts by the endothelium.These markers precede the signs of evident microangiopathy.Platelets have an ethiopathogenic relation to the microangiopathy in DM.Their increased activity was confirmed in both types of DM.Predictors of endothelial and platelet disorder could improve the screening of individuals at increased risk,thus leading to the early diagnosis,appropriate treatment,as well as to the effective prevention of the complications of DM2.In the article we deal with the mechanisms involved in the pathogenesis of endothelial and platelet functional abnormalities,endothelial and platelet markers of DM2 considered for implementation in clinical practice and possibilities of their detection.

Non-Vitamin K Antagonist Oral Anticoagulants: Redefining the Role of the Nurse to Improve Patient Care

Thromboembolic disorders and their associated long-term complications place a burden on patients, healthcare systems and society. Non-vitamin K antagonist (VKA) oral anticoagulants (OACs), including rivaroxaban, dabigatran, apixaban and edoxaban, are effective for the prevention of stroke in patients with non-valvular atrial fibrillation and for the treatment and secondary prevention of venous thromboembolism. The increasing uptake of the non-VKA OACs in primary care lessens the burden of care and allows for an easier transition of treatment from hospital to home. This transformation in terms of patient management has resulted in the need to empower nurses working in this field to endorse management strategies with a focus on patient education and long-term management (i.e. assessment of compliance, scheduling follow-up visits). Management of both venous thromboembolism and stroke prevention in patients with non-valvular atrial fibrillation requires a multidisciplinary team approach and, looking to the future, nurses are likely to have a key role at the heart of the thrombosis team. This review aims to provide nurses with the confidence to manage patients with thromboembolic disorders, and highlights the importance of responsible non-VKA OAC use and the impact that this can have on improving patient care and outcomes.