Q: The effect of clopidogrel may be ___________ in diabetic patients?
Physiologically, diabetic patients tend to have high platelet activation. This leads to relatively higher circulating immature platelets in their blood, and so the decreased function of anti-platelet drugs. The diabetic patients who present with coronary symptoms though should not be treated differently but their potential lack of response to Dual Anti-Platelet Therapy (DAPT) should be kept in mind.
Diabetic patients who are compliant but less responsive to DAPT, may require a higher dose of Aspirin (ASA) and/or stronger platelet inhibitors like prasugrel or ticagrelor instead of clopidogrel.
References:1. Bouman HJ, van Werkum JW, Hackeng CM, et al. The importance of anticoagulant agents in measuring platelet aggregation in patients treated with clopidogrel and aspirin. J Thromb Haemost 2008; 6:1040.