Oral antiplatelet therapy in diabetes mellitus and the role of prasugrel: an overview

Autor: Vijay K. Misra, Gilbert J. Zoghbi, Silvio E. Papapietro, William B. Hillegass, Brigitta C. Brott, James C Dobbs
Jazyk: angličtina
Rok vydání: 2011
Předmět:
medicine.medical_specialty
Prasugrel
Time Factors
Endocrinology
Diabetes and Metabolism
medicine.medical_treatment
Drug Resistance
Myocardial Infarction
Administration
Oral
Review
Coronary Artery Disease
Thiophenes
Piperazines
Coronary artery disease
Internal medicine
Diabetes mellitus
medicine
Humans
Pharmacology (medical)
acute coronary syndromes
Myocardial infarction
cardiovascular diseases
Angioplasty
Balloon
Coronary
Stroke
business.industry
percutaneous coronary intervention
Public Health
Environmental and Occupational Health
Percutaneous coronary intervention
Thrombosis
Hematology
General Medicine
medicine.disease
Clopidogrel
antithrombotic agents
prasugrel
Treatment Outcome
Cardiovascular Diseases
diabetes mellitus
Cardiology
Platelet aggregation inhibitor
Drug Therapy
Combination
Cardiology and Cardiovascular Medicine
business
Prasugrel Hydrochloride
Platelet Aggregation Inhibitors
medicine.drug
Zdroj: Vascular Health and Risk Management
ISSN: 1178-2048
1176-6344
Popis: 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.
Databáze: OpenAIRE
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