This review summarizes platelet abnormalities in type 2 diabetes and highlights the limited benefit of aspirin compared to the potential benefits of thienopyridines and glycoprotein IIb/IIIa inhibitors in high-risk patients.
Cautions against routine aspirin in diabetes; leaves open targeted trials of thienopyridines and GP IIb/IIIa inhibitors in high-risk patients.
Type 2 diabetes mellitus increases atherothrombotic risk. Platelets in individuals with diabetes show increased activity at baseline and in response to agonists, ultimately leading to increased aggregation. Increased expression of platelet surface adhesion molecules and receptors, enhanced production of thromboxane and thrombin and disturbances in platelet calcium homeostasis are well documented. As intra-arterial thrombi are initiated by platelets, strategies to limit acute thrombotic events have largely focused on antiplatelet agents. Aspirin remains the cornerstone of antiplatelet therapy but appears to have limited benefit in diabetes. Use of thienopyridines and platelet glycoprotein IIb/IIIa receptor inhibitors has been shown to benefit high-risk patient populations. This review summarises the different platelet abnormalities characterised in diabetes and the role of currently used antiplatelet agents.
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Natarajan et al. (2008) studied this question.
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