title: Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview.
abstract: Diabetics have a prothrombotic state that includes increased platelet reactivity. This contributes to the less favorable clinical outcomes observed in diabetics experiencing acute coronary syndromes as well as stable coronary artery disease. Many diabetics are relatively resistant to or have insufficient response to several antithrombotic agents. In the setting of percutaneous coronary intervention, hyporesponsiveness to clopidogrel is particularly common among diabetics. Several strategies have been examined to further enhance the benefits of oral antiplatelet therapy in diabetics. These include increasing the dose of clopidogrel, triple antiplatelet therapy with cilostazol, and new agents such as prasugrel. The large TRITON TIMI 38 randomized trial compared clopidogrel to prasugrel in the setting of percutaneous coronary intervention for acute coronary syndromes. The diabetic subgroup (n = 3146) experienced considerable incremental benefit with a 4.8% reduction in cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke at 15-month follow-up with prasugrel treatment. Among diabetics on insulin this combined endpoint was reduced by 7.9% at 15 months. Major bleeding was not increased in the diabetic subgroup. This confirms the general hypothesis that more potent oral antiplatelet therapy can partially overcome the prothrombotic milieu and safely improve important clinical outcomes in diabetics.
authors.affiliation: Columbiana Cardiovascular Consultants, Columbiana, AL 35051, USA. hillegas@mail.ad.uab.edu
authors.forename: William B
authors.initials: WB
authors.lastname: Hillegass
authors.forename: Brigitta C
authors.initials: BC
authors.lastname: Brott
authors.forename: James C
authors.initials: JC
authors.lastname: Dobbs
authors.forename: Silvio E
authors.initials: SE
authors.lastname: Papapietro
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Misra
authors.forename: Gilbert J
authors.initials: GJ
authors.lastname: Zoghbi
mesh_terms: D000284:Administration, Oral; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D003324:Coronary Artery Disease / Q000097:blood / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality / Q000503:physiopathology; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D006801:Humans; D009203:Myocardial Infarction / Q000517:prevention & control; D010879:Piperazines / Q000008:administration & dosage* / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D000068799:Prasugrel Hydrochloride; D020521:Stroke / Q000517:prevention & control; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010879:Piperazines; D010975:Platelet Aggregation Inhibitors; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride