[Antithrombotic agents and diabetes. Benefits and recommendations for use].
Diabetic patients (3% of the French population) have a higher risk of coronary and peripheral vascular disease than non-diabetic subjects and develop long-term microvascular renal and retinal complications. Abnormalities of coagulation, haemostasis and fibrinolysis have been demonstrated in diabetics and contribute to these complications. The prescription of antithrombotics is therefore common in these patients. Platelet antiaggregants (aspirin and ticlopidine) are effective in primary and secondary prevention in reducing the overall number of vascular events (reduction of 17% in the last ATC meta-analysis) and of coronary and cerebrovascular complications in particular. Two studies have shown a preventive effect of antiaggregants on diabetic retinopathy in its initial stages. With regards to the value of the use of these agents, there are few complications which may be limited by appropriate measures. One problem lies in the choice of aspirin dosage, most studies having been performed with high doses ranging from 500 to 1,300 mg per 24 hours. It is therefore difficult to recommend doses less than 300 to 500 mg per 24 hours. The prescription of anticoagulants (heparin, vitamin-K antagonists) is not associated with more problems in diabetics than in non-diabetics. The same applies to the use of thrombolytics in the acute phase of myocardial infarction: the risk of haemorrhages, especially intraocular, is only theoretical, only one case (regressive) having been reported to date. In conclusion, diabetes is more a priviledged indication than a contra-indication to the use of antithrombotic, platelet inhibitor, anticoagulant and thrombolytic agents.
Guillausseau
P J
PJ
Service de diabétologie, hôpital Lariboisière, Paris.
Dupuy
E
E
D000925:Anticoagulants / Q000627:therapeutic use*; D000075202:Contraindications; D003925:Diabetic Angiopathies / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D003930:Diabetic Retinopathy / Q000150:complications / Q000188:drug therapy / Q000517:prevention & control; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors
Antithrombotiques et diabète. Bénéfices et précautions d'emploi.