Key result
Switching to potent P2Y12 inhibitors, adding cilostazol, or dose escalation overcomes clopidogrel resistance in diabetes.
Why the study?
Diabetic patients undergoing PCI and stenting remain at increased risk of recurrent ischemic events despite dual antiplatelet therapy with clopidogrel and aspirin.
Diabetic patients post-PCI face elevated recurrent risk despite DAPT; leaves open need for optimized antiplatelet strategies in this group.
Platelets play a central role in the pathogenesis of atherothrombosis. 1) Thus, achieving platelet inhibition is an important part of managing patients that have experienced an atherothrombotic event.Dual antiplatelet therapy with clopidogrel plus aspirin has been shown to markedly reduce ischemic events in patients undergoing percutaneous coronary intervention (PCI) and stenting. 2)Despite its proven benefit of dual antiplatelet therapy, diabetic patients remain at increased risk of recurrent ischemic events when compared to non-diabetic patients.
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Jang‐Young Kim (2009) conducted an editorial in Clopidogrel low responsiveness in diabetes mellitus and stent implantation. Alternative antiplatelet strategies (cilostazol, high-dose clopidogrel, prasugrel, ticagrelor) vs. Standard clopidogrel therapy was evaluated. Practical strategies to overcome clopidogrel low responsiveness in diabetic patients include adding cilostazol, increasing the clopidogrel dose, or using newer agents such as prasugrel or ticagrelor.
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