Antiplatelet therapy in type 2 diabetes mellitus

Patients with diabetes mellitus are characterized by a prothrombotic status. Since platelet reactivity is key to the development of atherothrombotic complications, antiplatelet therapy has a pivotal role in reducing ischemic risk, especially in diabetes mellitus patients. This review summarizes the current knowledge on how antiplatelet therapy affects this high-risk patient population.

Numerous studies have shown the clinical benefit of antiplatelet agents in reducing ischemic events in diabetes mellitus patients. Despite the clinical benefit achieved with antiplatelet agents, however, patients with diabetes mellitus continue to have an increased risk of ischemic events compared to non-diabetes mellitus. Recent observations suggest that this may be in part due to inadequate platelet inhibition achieved in diabetes mellitus patients compared to non-diabetics, exposing these subjects to an enhanced ischemic risk.

Whilst antiplatelet therapy has been clearly shown to reduce morbidity and mortality in patients with diabetes mellitus, there are accruing data demonstrating that in these patients the degree of platelet inhibition achieved with standard treatment regimens may be inadequate. This supports the need for specific antiplatelet drug regimens, with either different dosages of current medication or development of novel antiplatelet drugs, which are more specific to tackle the hyperreactive diabetic platelet.