Antithrombotic therapy in diabetes: which, when, and for how long?

Area of Science:

• Cardiology
• Endocrinology
• Hematology

Background:

• Diabetes mellitus (DM) significantly increases cardiovascular mortality and morbidity.
• Individuals with DM experience premature, aggressive atherosclerosis and a prothrombotic state.
• Current thrombosis management in DM often mirrors that of non-diabetic populations, despite unique risks.

Purpose of the Study:

• To provide an updated review of antithrombotic management strategies for individuals with diabetes mellitus.
• To discuss primary and secondary vascular prevention in DM patients.
• To examine current and emerging antithrombotic therapies in various clinical contexts.

Main Methods:

• Comprehensive literature review of antithrombotic therapies in diabetes.
• Analysis of evidence for antiplatelet and anticoagulant combinations.
• Examination of management in acute and long-term settings, including specific patient subgroups.

Main Results:

• DM patients have a complex atherothrombotic risk profile due to increased platelet activity and impaired fibrinolysis.
• Therapeutic strategies need tailoring based on individual risk factors, DM duration, and bleeding predisposition.
• Evidence supports combined antiplatelet and anticoagulant therapies in specific scenarios.

Conclusions:

• Optimizing antithrombotic therapy in DM requires personalized approaches beyond standard guidelines.
• Further research is needed to address knowledge gaps and improve clinical outcomes in this high-risk population.
• Effective management involves balancing thrombosis prevention with bleeding risk.