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[Antithrombotic agents and diabetes. Benefits and recommendations for use]
1Service de diabétologie, hôpital Lariboisière, Paris.
Insights
Diabetic patients face higher vascular risks, but antithrombotic therapies like antiplatelets are beneficial. These treatments are generally safe and indicated for managing diabetes-related vascular complications.
Area of Science:
- Cardiology
- Diabetology
- Hematology
Background:
- Diabetic patients have increased risks of vascular diseases and microvascular complications.
- Coagulation and fibrinolysis abnormalities are prevalent in diabetics, contributing to these complications.
- Antithrombotic therapies are frequently prescribed for diabetic patients.
Purpose of the Study:
- To evaluate the efficacy and safety of antithrombotic agents in diabetic patients.
- To assess the role of antiplatelet agents in preventing vascular events and retinopathy.
- To determine if diabetes is a contraindication for antithrombotic therapies.
Main Methods:
- Review of existing meta-analyses and studies on antithrombotic use in diabetics.
- Analysis of data on antiplatelet agents (aspirin, ticlopidine), anticoagulants, and thrombolytics.
- Examination of complication rates, particularly hemorrhage, in diabetic versus non-diabetic populations.
Main Results:
- Antiplatelet agents reduce vascular events by 17% and show preventive effects on early diabetic retinopathy.
- Anticoagulants and thrombolytics do not pose significantly more risks in diabetics compared to non-diabetics.
- Hemorrhagic risks, especially intraocular, are theoretical with thrombolytics, with only one reported case.
Conclusions:
- Diabetes is a primary indication, not a contraindication, for antithrombotic, antiplatelet, anticoagulant, and thrombolytic therapies.
- Appropriate measures can minimize potential complications associated with these treatments.
- Careful consideration of aspirin dosage is necessary, with optimal ranges still debated.
Abstract:
Diabetic patients (3% of the French population) have a higher risk of coronary and peripheral vascular disease than non-diabetic subjects and develop long-term microvascular renal and retinal complications. Abnormalities of coagulation, haemostasis and fibrinolysis have been demonstrated in diabetics and contribute to these complications. The prescription of antithrombotics is therefore common in these patients. Platelet antiaggregants (aspirin and ticlopidine) are effective in primary and secondary prevention in reducing the overall number of vascular events (reduction of 17% in the last ATC meta-analysis) and of coronary and cerebrovascular complications in particular. Two studies have shown a preventive effect of antiaggregants on diabetic retinopathy in its initial stages. With regards to the value of the use of these agents, there are few complications which may be limited by appropriate measures. One problem lies in the choice of aspirin dosage, most studies having been performed with high doses ranging from 500 to 1,300 mg per 24 hours. It is therefore difficult to recommend doses less than 300 to 500 mg per 24 hours. The prescription of anticoagulants (heparin, vitamin-K antagonists) is not associated with more problems in diabetics than in non-diabetics. The same applies to the use of thrombolytics in the acute phase of myocardial infarction: the risk of haemorrhages, especially intraocular, is only theoretical, only one case (regressive) having been reported to date. In conclusion, diabetes is more a priviledged indication than a contra-indication to the use of antithrombotic, platelet inhibitor, anticoagulant and thrombolytic agents.