Antiplatelet Therapy Following Myocardial Infarction in Patients With Diabetes

Bhatt, Deepak L.

doi:10.1001/2012.jama.11467

Cited by 11 publications

(4 citation statements)

References 18 publications

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“…It can affect any artery in the body including arteries in the heart, brain, arms, legs, pelvis, and kidneys. Atherosclerosis may cause CAD when there is a restriction of blood flow to the heart, or PAD, which causes stenosis and occlusion of noncerebral and noncoronary arteries affecting the arteries of the lower extremities and sometimes the carotid arteries [1,2]. CAD or PAD poses a substantial clinical and economic burden, being associated with a high risk of cardiovascular (CV) death, MI, and stroke, which increases further in patients with prior MI, stroke, or renal impairment.…”

Section: Introductionmentioning

confidence: 99%

Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials

Bauersachs

Brière

et al. 2020

Cardiovascular Therapeutics

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Aims. Acetylsalicylic acid (ASA) is widely used for the prevention of atherothrombotic events in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD), but the risk of vascular events remains high. We aimed at identifying randomised controlled trials (RCTs) on antithrombotic treatments in patients with chronic CAD or PAD. Methods. Searches were conducted on MEDLINE, EMBASE, and CENTRAL on March 1st, 2018. This systematic review (SR) uses a narrative synthesis to summarize the evidence for the efficacy and safety of antiplatelet and anticoagulant therapies in the population of both chronic CAD or PAD patients. Results. Four RCTs from 27 publications were included. Study groups included 15,603 to 27,395 patients. ASA alone was the most extensively studied (n=3); other studies included rivaroxaban with or without ASA (n=1), vorapaxar alone (n=1), and clopidogrel with (n=1) or without ASA (n=1). Clopidogrel alone and clopidogrel plus ASA compared to ASA presented similar efficacy with comparable safety profile. Rivaroxaban plus ASA significantly reduced the risk of the composite of cardiovascular death, myocardial infarction, and stroke compared to ASA alone, although major bleeding with rivaroxaban plus ASA increased. Conclusion. There is limited and heterogeneous evidence on the prevention of atherothrombotic events in patients with chronic CAD or PAD. Clopidogrel alone and clopidogrel plus ASA did not demonstrate superiority over ASA alone. A combination of rivaroxaban plus ASA may offer significant additional benefit in reducing cardiovascular outcomes, yet it may increase the risk of bleeding, compared to ASA alone.

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Section: Introductionmentioning

confidence: 99%

Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials

Bauersachs

Brière

et al. 2020

Cardiovascular Therapeutics

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“…Diabetes accelerates coronary, cerebrovascular and peripheral vascular atherosclerotic disease and increases the risk of thromboembolic events 10–12. Diabetes is also an independent risk factor for heart failure hospitalisations and death 13–15.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes accelerates coronary, cerebrovascular and peripheral vascular atherosclerotic disease and increases the risk of thromboembolic events. [10][11][12] Diabetes is also an independent risk factor for heart failure hospitalisations and death. [13][14][15] The data in this analysis support these facts even though individuals diagnosed with diabetes in our analysis had a decreased prevalence of moderate and severe NYHA functional classification.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular effects of rivaroxaban in heart failure patients with sinus rhythm and coronary disease with and without diabetes: a retrospective international cohort study from COMMANDER-HF

et al. 2023

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ObjectivesCOMMANDER-HF was a randomised trial comparing rivaroxaban 2.5 mg two times a day to placebo, in addition to antiplatelet therapy, in patients hospitalised for worsening heart failure with coronary artery disease and sinus rhythm. Patients with diabetes are at increased risk of cardiovascular events and therefore have more to gain.Methods and resultsIn this post-hoc analysis, we evaluated the efficacy and safety of rivaroxaban in patients with (n=2052) and without diabetes (n=2970). The primary outcome was the composite of cardiovascular death, myocardial infarction (MI) or ischaemic stroke. HRs and 95% CIs with interaction analyses were used to describe event-rates and treatment effects. Patients with diabetes had a higher prevalence of cardiovascular comorbidities (eg, hypertension, obesity) and increased incidence of cardiovascular events. Adjusted HRs for events in people with versus without diabetes were 1.34 (95% CI 1.19 to 1.50) for the primary outcome, 1.21 (95% CI 0.84 to 1.75) for stroke, 1.51 (95% CI 1.14 to 1.99) for MI, 1.17 (95% CI 1.05 to 1.31) for heart failure hospitalisation and 1.06 (95% CI 0.56 to 2.01) for major bleeding. Rivaroxaban had no significant effect on event-rates in patients with and without diabetes (all interaction p values >0.05). Low-dose rivaroxaban was associated with an overall reduction in ischaemic stroke (HR 0.66; 95% CI 0.47 to 0.95), with no apparent subgroup interaction according to diabetes status (p-int=0.93).ConclusionsIn COMMANDER-HF a diagnosis of diabetes conferred higher rates of cardiovascular events that, with exception of ischaemic stroke, was not substantially reduced by rivaroxaban. Rivaroxaban was associated with reduced risk of ischaemic stroke for patients with and without diabetes.Trial registration numberNCT01877915; Post-results.

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“…This imbalance results in diabetic thrombocytopathy [8], a condition that majorly affects platelet function and ultimately results in heart attacks or stroke in diabetes [9][10][11][12]. Scientific research has shown that antiplatelet therapy can reduce cardiovascular complications in diabetes and premature death [13,14].…”

Section: Introductionmentioning

confidence: 99%

Understanding the Activation of Platelets in Diabetes and Its Modulation by Allyl Methyl Sulfide, an Active Metabolite of Garlic

Malladi

Johny

Uppulapu

et al. 2021

Journal of Diabetes Research

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Background. Diabetes mellitus (DM) is a chronic metabolic disorder associated with higher risk of having cardiovascular disease. Platelets play a promising role in the pathogenesis of cardiovascular complications in diabetes. Since last several decades, garlic and its bioactive components are extensively studied in diabetes and its complications. Our aim was to explore the antiplatelet property of allyl methyl sulfide (AMS) focusing on ameliorating platelet activation in diabetes. Method. We used streptozotocin- (STZ-) induced diabetic rats as model for type 1 diabetes. We have evaluated the effect of allyl methyl sulfide on platelet activation by administrating AMS to diabetic rats for 10 weeks. Flow cytometry-based analysis was used to evaluate the platelet activation, platelet aggregation, platelet macrophage interaction, and endogenous ROS generation in the platelets obtained from control, diabetes, and AMS- and aspirin-treated diabetic rats. Results. AMS treatment for 10 weeks effectively reduced the blood glucose levels in diabetic rats. Three weeks of AMS (50 mg/kg/day) treatment did not reduce the activation of platelets but a significant ( p < 0.05 ) decrease was observed after 10 weeks of treatment. Oral administration of AMS significantly ( p < 0.05 ) reduced the baseline and also reduced ADP-induced aggregation of platelets after 3 and 10 weeks of treatment. Furthermore, 10 weeks of AMS treatment in diabetic rats attenuated the endogenous ROS content ( p < 0.05 ) of platelets and platelet macrophage interactions. The inhibition of platelet activation in diabetic rats after AMS treatment was comparable with aspirin treatment (30 mg/kg/day). Conclusion. We observed an inhibitory effect of allyl methyl sulfide on platelet aggregation, platelet activation, platelet macrophage interaction, and increased ROS levels in type 1 diabetes. Our data suggests that AMS can be useful to control cardiovascular complication in diabetes via inhibition of platelet activation.

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Antiplatelet Therapy Following Myocardial Infarction in Patients With Diabetes

Cited by 11 publications

References 18 publications

Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials

Antithrombotic Treatments in Patients with Chronic Coronary Artery Disease or Peripheral Artery Disease: A Systematic Review of Randomised Controlled Trials

Cardiovascular effects of rivaroxaban in heart failure patients with sinus rhythm and coronary disease with and without diabetes: a retrospective international cohort study from COMMANDER-HF

Understanding the Activation of Platelets in Diabetes and Its Modulation by Allyl Methyl Sulfide, an Active Metabolite of Garlic

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