Aspirin response and failure in diabetic patients with cardiovascular disease

Platelets are known to play a pivotal role not only in the formation of arterial thrombosis but also in the progression of atherosclerotic disease. Recent data suggest that these activities of platelets have become enhanced in patients with type 2 diabetes, accounting for many of the cardiovascular complications. Although aspirin is the most commonly used drug to regulate platelet function, many patients do not receive the expected clinical benefit of this drug and do not have the expected inhibition of platelet function, perhaps because of platelet hyperactivity in diabetes. The data suggest that aspirin might be a less than adequate antithrombotic for type 2 diabetes and that alternative therapies (e.g. combinations with clopidogrel or new antithrombotic therapies) are required to effectively manage the prevalent thrombotic complications associated with this disease.