DAPT and Diabetes

 Q: The effect of clopidogrel may be ___________ in diabetic patients?

A) decreased

B) increased

Answer: A

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.

#cardiology

#pharmacology

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. 

2. Duzenli MA, Ozdemir K, Aygul N, et al. Comparison of increased aspirin dose versus combined aspirin plus clopidogrel therapy in patients with diabetes mellitus and coronary heart disease and impaired antiplatelet response to low-dose aspirin. Am J Cardiol 2008; 102:396. 

3. Angiolillo DJ, Bernardo E, Zanoni M, et al. Impact of insulin receptor substrate-1 genotypes on platelet reactivity and cardiovascular outcomes in patients with type 2 diabetes mellitus and coronary artery disease. J Am Coll Cardiol 2011; 58:30. 

4. Grove EL, Hvas AM, Kristensen SD. Immature platelets in patients with acute coronary syndromes. Thromb Haemost 2009; 101:151. 

5. Michos ED, Ardehali R, Blumenthal RS, et al. Aspirin and clopidogrel resistance. Mayo Clin Proc 2006; 81:518. 

6. 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.