Key result
Conservative ACS management in type 2 diabetes requires extended anticoagulation, lifelong DAPT, and specific beta-blockers.
Highlights specific pharmacological adjustments necessary when managing acute coronary syndrome in patients with type 2 diabetes mellitus, emphasizing safety and physiological differences.
Supports tailored conservative ACS therapy in T2DM; hypothesis-generating and should not yet change practice without RCTs.
2 diabetes mellitus (T2DM). Dyspnea during physical exertion should be considered an anginal equivalent in patients with T2DM, and suffocation causing admission to ICU ? as a possible sign of myocardial infarction. Proximal and distal coronary lesions combined with diabetic microangiopathy compromising collateral circulation are a frequent finding in these patients. Therefore an infusion of nitroglycerine may yield a rapid improvement in their condition. Treatment with low-molecular-weight heparin (LMWH) should be administered for a longer period due to rheological disturbances in T2DM. Diabetic patients with a history of myocardial infarction (MI) should receive a life-long therapeutic combination of two different antiplatelet agents. Carvedilol, a non-selective beta blocker/ alpha-1 blocker, and selective beta-1 blockers (e.g. nebivolol, bisoprolol) have better safety profile than other beta blockers concerning neurological aspects of hypoglycemic events.
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Kakorin et al. (2013) conducted a review in Acute coronary syndrome with type 2 diabetes mellitus. Conservative therapy (LMWH, antiplatelets, beta-blockers, ACE inhibitors, statins, nitrates) was evaluated. Conservative treatment for acute coronary syndrome in patients with type 2 diabetes mellitus requires prolonged low-molecular-weight heparin, lifelong dual antiplatelets, and specific beta-blockers.
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