Study provide further evidence of increased platelet aggregation and activation in type 2 diabetics compared with nondiabetics, even in the presence of dual antiplatelet therapy with aspirin and clopidogrel.
"Since increased platelet reactivity contributes to the enhanced cardiovascular risk of diabetics, tailoring treatment using higher doses of antiplatelet drugs or introduction of novel drugs more specific for the diabetic platelet and able to achieve greater platelet inhibition is warranted in this high-risk patient population," Dr. Dominick J. Angiolillo from the University of Florida in Jacksonville told Reuters Health.
Dr. Angiolillo and colleagues report the results of their study of how platelets from diabetic patients respond to dual antiplatelet therapy (aspirin plus clopidogrel) compared with nondiabetics.
"Platelet dysfunction in diabetic patients was observed acutely after a 300-mg clopidogrel loading dose and persisted after long-term combined clopidogrel and aspirin therapy," the investigators report.
"The main finding of this study," Dr. Angiolillo elaborated, "is that platelets from diabetic patients have a lower response to standard dosing of clopidogrel and have increased platelet reactivity compared to platelets from non-diabetics." Confirming previous reports, diabetics also mount a lower response to aspirin resulting in increased platelet reactivity, the researcher added.
Moreover, while platelet reactivity was reduced in diabetics using dual antiplatelet therapy, platelet reactivity is still "significantly increased compared to non-diabetics using the same therapeutic regimen," Dr. Angiolillo also pointed out. Increased platelet reactivity is well known to be associated with future risk of cardiovascular events.
The investigator added that the study lends further support to the hypothesis that antiplatelet treatment "should be individualized according to a patient’s need, similar to how we adjust the dose of lipid-lowering drugs according to a patient’s cholesterol level."
"Such approach would allow, on one hand, to reduce the risk of bleeding in patients who over-respond to antiplatelet drugs and, on the other, reduce the risk of ischemic events of patients who have a suboptimal response," Dr. Angiolillo noted.
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