Aldose reductase-mediated effects of hyperglycemia on the coagulation system. Flux of glucose via aldose reductase into the polyol pathway generates ROS. ROS formation depresses miR-24, which releases this miRNA’s block on VWF secretion and results in elevated VWF plasma levels. Aldose reductase-mediated ROS formation also causes platelet hyperreactivity and mitochondrial damage. Red lines, negative regulation; black arrows, positive regulation. Professional illustration by Patrick Lane, ScEYEnce Studios.