Antithrombotic therapy in patients with coronary artery disease and with type 2 diabetes mellitus.
Diabetes mellitus (DM) is a life-threatening disease. Patients with DM have a 2- to 4-fold higher risk of developing cardiovascular disease compared to their non-diabetic counterparts. Several drugs are available for the treatment of stable coronary artery disease (CAD) and acute coronary syndrome (ACS). Among oral antiplatelet agents (acetylsalicylic acid, ticlopidine, clopidogrel, and prasugrel), prasugrel has shown the highest efficacy in patients with DM and ACS. The use of glycoprotein IIb-IIIa receptor inhibitors in diabetic subjects with ACS undergoing percutaneous coronary intervention (PCI) reduces adverse clinical events in a greater extent than in non-diabetics. Several direct and indirect antithrombins are recommended for the treatment of ACS such as unfractionated heparin (UFH), enoxaparin, fondaparinux, and bivalirudin. Enoxaparin and bivalirudin have been shown to be superior to UFH among patients with ST-elevation MI (STEMI) and non-ST elevation MI (NSTEMI) also in diabetic subgroup analyses.
Third Department of Cardiology and Emergency Medicine, Wilhelminen Hospital, Vienna, Austria. serdar.farhan@wienkav.at
Serdar
S
Farhan
Thomas
T
Höchtl
Alexandra
A
Kautzky-Willer
Johann
J
Wojta
Kurt
K
Huber
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000188:drug therapy*; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000097:blood* / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex