Friday, June 5, 2020

Diabetes and Plavix

Q: Diabetic patients may require? (select)

A) Higher dose of clopidogrel 
B) Lower dose of clopidogrel

Answer: A

Diabetic patients may require higher than standard dose of clopidogrel due to the reason that by default they have a higher percent of circulating immature platelets. This characteristics may counteract the inhibitory effect of clopidogrel on platelets. Although evidence in this regard is weak. Diabetic patients may respond better to other platelet inhibitor like prasugrel or ticagrelor.




1. Gurbel PA, Bliden KP, Hiatt BL, O'Connor CM. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107:2908. 

2. Mangiacapra F, Patti G, Peace A, et al. Comparison of platelet reactivity and periprocedural outcomes in patients with versus without diabetes mellitus and treated with clopidogrel and percutaneous coronary intervention. Am J Cardiol 2010; 106:619. 

3. Gurbel PA, Bliden KP, Butler K, et al. Response to ticagrelor in clopidogrel nonresponders and responders and effect of switching therapies: the RESPOND study. Circulation 2010; 121:1188. 

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