Antithrombotic Treatment in Diabetes Mellitus: A Review of the Literature about Antiplatelet and Anticoagulation Strategies Used for Diabetic Patients in Primary and Secondary Prevention

Abstract

Background: Diabetes mellitus (DM) is on the rise globally. Its prevalence has nearly doubled during the last two decades and it is estimated to affect 8.8% of the global population. Cardiovascular disease (CVD) is the leading cause of death in diabetic population and despite modern anti-inflammatory and cardioprotective therapeutic strategies diabetic patients have at least a twice fold risk of cardiovascular events. Prothrombotic state in DM is associated with multiple determinants such as platelet alterations, oxidative stress, endothelial changes, circulating mediators. Thus, proper antithrombotic strategies to reduce the risk of CVD in this population is critical. Methods: This article reviews the current antiplatelet and anticoagulant agents in the aspect of primary and secondary prevention of CVD in the diabetic population. Results: The use of aspirin may be considered only at high-risk patients in the absence of contraindications. Cangrelor was not inferior to clopidogrel in preventing the composite outcome of CV death, myocardial infraction and revascularization without increasing major bleeding. Triple therapy in the subpopulation with DM significantly reduced the composite primary outcome of CV death, myocardial infraction or repeat target lesion revascularization. That was not the case for stent thrombosis, which was similar in both groups. Importantly, triple therapy did not result in increased bleeding complications, which were similar in both groups. However, cilostazol is linked to various adverse effects (e.g., headache, palpitations, and gastrointestinal disturbances) that drive many patients to withdrawal. Conclusion: In conclusion, DM is a rapidly growing disease that increases the risk of CVD, AF, and CV mortality. Proper antithrombotic strategies to reduce CVD risk in DM is a necessity. Also, new antithrombotic treatments and combination therapies may play a critical role to overcome antiplatelet resistance in DM patients and reduce morbidity and mortality attributed to CVD.

Role of EPA in Inflammation: Mechanisms, Effects, and Clinical Relevance

“…Indeed, the Framingham Heart Study in the 1950s demonstrated that hypercholesterolemia accelerates atherosclerosis in humans [ 3 ]. In the study of cardiovascular diseases, great importance was given to the thrombotic aspect, which still represents the greatest risk in the management of low-grade systemic inflammation; in fact, there are numerous studies that underline the link between the mediators of inflammation and platelet activation [ 8 ].…”

Extensive thrombosis with amputation of digit I pedis dextra: A case report in Indonesian adult with type 2 diabetes mellitus

“…Second, the elderly are often accompanied by various comorbidities so that receiving large amounts of drugs will increase the risk of interactions with the antithrombotic drugs given. Therefore, therapy monitoring must be carried out more carefully on the dose, drug effects, or side effects of drugs [17] , [18] .…”

Nutrition, dietary habits, and weight management to prevent and treat patients with peripheral artery disease

“…Similarly, increased levels of vitamins K and E, with parallel administration of warfarin as anticoagulation therapy for PAD's comorbidities, have been associated with vascular calcification. Thus, patients on coumadin should be routinely monitored for these nutrient deficiencies and at the same time evaluated for candidacy for newer oral anticoagulants (Foley et al, 2017;Kokkinidis et al, 2020a;Siasos et al, 2020). Novel oral anticoagulants in combination with aspirin may provide an alternative treatment in PAD, however, it is deemed necessary to identify patient subgroups who will benefit the most (Koutsoumpelis et al, 2018).…”