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The Association between Glycosylated Hemoglobin Level and Platelets Reactivity in Patients with Diabetes Mellitus
Martina Zrno Mihaljevic1, Mate Petricevic2, Sanja Konosic3
1Department of Cardiovascular Diseases, University Hospital Centre Zagreb, University of Zagreb, Zagreb, Croatia.
Insights
Diabetic patients undergoing coronary artery bypass grafting show increased platelet reactivity and aspirin resistance, particularly those with higher HbA1c levels. Early assessment and tailored antiplatelet therapy are recommended post-surgery.
Area of Science:
- Cardiology
- Diabetology
- Pharmacology
Background:
- Diabetic patients exhibit heightened platelet reactivity post-coronary artery bypass grafting (CABG).
- Elevated hemoglobin A1c (HbA1c) is linked to increased cardiovascular risk in diabetic individuals.
Purpose of the Study:
- To investigate the association between HbA1c levels and platelet reactivity in CABG patients.
- To evaluate the clinical impact of HbA1c-related platelet function on outcomes after CABG.
Main Methods:
- Prospective observational study of 225 diabetic patients undergoing CABG.
- Analysis of HbA1c and platelet function (multiple electrode aggregometry) pre-surgery and on postoperative day 4.
- Patients stratified into HbA1c < 7% and HbA1c ≥ 7% groups.
Main Results:
- Postoperative platelet reactivity (ASPI and ADP tests) significantly increased compared to preoperative values.
- Aspirin resistance (AR) prevalence rose from 46.4% pre-surgery to 57.2% post-surgery.
- Higher AR prevalence was observed in the HbA1c < 7% group compared to the HbA1c ≥ 7% group, both pre- and post-surgery.
Conclusions:
- Perioperative platelet reactivity assessment in diabetics identifies those at risk for ischemic events.
- Personalized antiplatelet therapy guided by platelet function testing may benefit high-risk diabetic patients post-CABG.
Background:
Diabetic patients tend to have increased platelet reactivity after coronary artery bypass grafting (CABG). The aim of this study was to determine the association between hemoglobin A1c (HbA1c) values and platelet reactivity and to evaluate the consequent impact on clinical outcomes in patients undergoing CABG.
Methods:
This prospective observational trial consecutively enrolled 225 diabetic patients undergoing CABG, between February 2014 and October 2018. HbA1c levels and platelet function (multiple electrode aggregometry [MEA]) were analyzed the day before surgery and on postoperative day 4 (POD 4). Patients were divided into two groups according to the HbA1c value: HBA1c < 7% and HbA1c ≥ 7%.
Results:
Significantly higher postoperative ASPI (platelet function test based on arachidonic acid) and ADP (platelet function test based on adenosine diphosphate) test values were observed at POD 4 compared with preoperative values (ASPI test: p < 0.001; ADP test: p < 0.001). The prevalence of preoperative aspirin resistance (AR) was 46.4% relative to 57.2% after surgery showing consistent increase in postoperative AR by approximately 10%. In addition, the prevalence of AR in the HbA1c < 7% group was higher by 10% compared with the HbA1c ≥ 7% group, both before and after surgery. We did not demonstrate differences in clinical outcomes between the HbA1c groups.
Conclusion:
Perioperative assessment of platelet reactivity in diabetic patients detects those with AR who may be at increased risk of adverse ischemic events. A personalized approach guided by MEA and administration of early and more potent antiaggregation therapy after CABG can be beneficial in this group of patients.
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