Title:Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention
Volume: 26
Issue: 23
Author(s): Gerasimos Siasos*, Georgia Skotsimara, Evangelos Oikonomou, Marios Sagris, Mystakidi Vasiliki-Chara, Evanthia Bletsa, Panagiota Stampouloglou, Panagiotis Theofilis, Georgios Charalampous and Dimitris Tousoulis
Affiliation:
- First Department of Cardiology, Hippokration Hospital, Athens Medical School, 114 Vas. Sofias avenue, 11527, Athens,Greece
Keywords:
Diabetes mellitus, cardiovascular disease, antiplatelets, anticoagulation, clopidogrel, myocardial infarction.
Abstract: Background: Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled during
the last two decades and it is estimated to affect 8.8% of the global population. Cardiovascular disease (CVD) is
the leading cause of death in the diabetic population and despite modern anti-inflammatory and cardioprotective
therapeutic strategies, diabetic patients have at least a twice fold risk of cardiovascular events. The prothrombotic
state in DM is associated with multiple determinants such as platelet alterations, oxidative stress, endothelial
changes, circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this population
are critical.
Methods: This article reviews the current antiplatelet and anticoagulant agents in the aspect of primary and secondary
prevention of CVD in the diabetic population.
Results: The use of aspirin may be considered only at high-risk patients in the absence of contraindications. Cangrelor
was not inferior to clopidogrel in preventing the composite outcome of CV death, myocardial infarction
and revascularization without increasing major bleeding. Triple therapy in the subpopulation with DM significantly
reduced the composite primary outcome of CV death, myocardial infarction or repeat target lesion revascularization.
That was not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy
did not result in increased bleeding complications, which were similar in both groups. However, cilostazol is
linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal disturbances) that drive many
patients to withdrawal.
Conclusion: In conclusion, DM is a rapidly growing disease that increases the risk of CVD, AF, and CV mortality.
Proper antithrombotic strategies to reduce CVD risk in DM are a necessity. Moreover, new antithrombotic
treatments and combination therapies may play a critical role to overcome antiplatelet resistance in DM patients
and reduce morbidity and mortality attributed to CVD.
