title: Tackling the thrombotic burden in patients with acute coronary syndrome and diabetes mellitus.
abstract: Patients with diabetes mellitus (DM) and coronary artery disease, particularly those presenting with acute coronary syndromes (ACS), have a higher risk of developing ischemic complications than their nondiabetic counterparts. Although ACS patients with DM benefit more than normoglycemic ACS patients from early coronary angiography and revascularization, they remain at a higher risk of complications following percutaneous coronary intervention and bypass surgery. The DM-associated prothrombotic state has been implicated in the pathogenesis of these complications and growing data supports the notion that potent platelet inhibition is of paramount importance in order to optimize outcomes of DM patients presenting with ACS. This article focuses on the evidence supporting the concept that augmented platelet reactivity and impaired responsiveness to oral antiplatelet agents are influential drivers of the increased propensity of DM patients with ACS to develop thrombotic complications. In particular, strategies to enhance platelet P2Y(12) receptor inhibition, a key factor to improve outcomes in this patient population, are reviewed.
authors.affiliation: University of Florida College of Medicine-Jacksonville, Division of Cardiology - ACC Building 5th floor, 655 West 8th Street, Jacksonville, FL 32209, USA. dominick.angiolillo@jax.ufl.edu
authors.forename: Dominick J
authors.initials: DJ
authors.lastname: Angiolillo
authors.forename: Marco
authors.initials: M
authors.lastname: Roffi
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernandez-Ortiz
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000628:therapy; D001792:Blood Platelets / Q000187:drug effects / Q000378:metabolism; D048909:Diabetes Complications / Q000188:drug therapy* / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000503:physiopathology; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D058925:Receptors, Purinergic P2Y12 / Q000187:drug effects; D013927:Thrombosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12