DM and DAPT

Q: Patients with diabetes mellitus may require ______________ dose of clopidogrel? (select one)

A) higher

B) lower

Answer: A

Patients with diabetes mellitus tend to have increased platelet activation, which means they may have a higher number of immature platelets circulating. This may affect the inhibitory effect of clopidogrel. Similar concerns can be applied to aspirin (ASA) in these platelets.

Patients with diabetes mellitus may require higher doses of ASA and clopidogrel. The other option is to use alternate agents.

#pharmacology

#cardiology

#endocrinology

References:

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.