Antiplatelet therapy use in diabetes mellitus patients: modern approaches and ischemic heart disease prevention perspectives

Novikov, V. I.; Novikov, K.Yu.

doi:10.26442/2075-1753_2018.4.16-23

Cited by 2 publications

(2 citation statements)

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“…Кроме того, у пациентов с сердечно-сосудистыми заболеваниями в сочетании с СД 2-го типа применение ацетилсалициловой кислоты (АСК) ассоциируется с меньшим антиагрегантным эффектом. Имеется точка зрения, что недостаточный контроль гликемии у пациентов с СД 2-го типа может быть одной из причин пониженного ответа на назначение АСК [21]. Оптимизация гликемического контроля может сопровождаться повышением антиагрегантного эффекта АСК.…”

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Management of ischemic risk events in patients with multifocal atherosclerosis and type 2 diabetes mellitus

Барбараш¹,

Кашталап²

2020

Aterotromboz

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The review article presents current positions about prevalence of multifocal atherosclerosis and type 2 diabetes mellitus in patients with coronary artery disease (CAD). Existing approaches to the assessment and management of high risk of ischemic events in such patients are identified. Based on the results of clinical trials, the main positions have been identified on risk prevention of cardiovascular complications in patients with combination of multifocal atherosclerosis and type 2 diabetes mellitus. The results of the COMPASS study on the use of a combination of rivaroxaban 2.5 mg twice a day and a low dose of acetylsalicylic acid in patients with CAD and/or multifocal atherosclerosis are presented, which is accompanied by a significant reduction in the risk of cardiovascular events. This approach demonstrated a increase in the risk of massive bleedings, but mainly in the first year of treatment and without significant subsequent increase. At the same time, in the group of combination therapy rivaroxaban and acetylsalicylic acid there was no increase in the frequency of the most severe bleeding - fatal, intracranial and into the critical organs, compared to the group of monotherapy of acetylsalicylic acid. These two facts show a perfectly acceptable level of hemorrhagic risk for translation into real clinical practice. Hemorrhagic risk management capabilities were considered in a CoMPASS study by prescribing proton pump inhibitors to patients. The data on the COMPASS sub-analysis on evaluation of effectiveness and safety of combined antithrombotic therapy in patients with CAD and/or multifocal atherosclerosis and type 2 diabetes mellitus are presented. They showed the possibility of usage such approach in patient management in routine clinical practice. Patients with very high risk of ischemic events: ischemic heart disease and multifocal atherosclerosis, as well as type 2 diabetes mellitus, particularly need to improve approaches to antithrombotic therapy.

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Section: материал обзораunclassified

Management of ischemic risk events in patients with multifocal atherosclerosis and type 2 diabetes mellitus

Барбараш¹,

Кашталап²

2020

Aterotromboz

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“…Наряду с этим доказано, что у больных с различным стажем СД по сравнению со здоровыми лицами увеличено количество активированных тромбоцитов. При улучшении гликемического контроля количество активированных форм тромбоцитов оставалось высоким [20].…”

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The main pathogenetic mechanisms of hypercoagulation in diabetes and the possibility of its drug correction

Kryukov

Владимирович²,

Кучмин

et al. 2021

Bulletin of the Russian Military Medical Academy

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Disorders in the blood coagulation system play an important role in the development of cardiovascular pathology in diabetes. Factors that cause them are hyperglycemia, insulin deficiency, insulin resistance, dyslipidemia, oxidative stress. The most significant changes are observed in the vascular-platelet link of hemostasis. Diabetes is characterized by morphological and functional changes in the endothelium of blood vessels. The activity of platelets increases, which is manifested by their high level of spontaneous aggregation and increased sensitivity to the action of activating factors. The role in the disturbance of hemostasis is played by increasing the activity of the von Willebrand factor, reflecting damage to endothelial cells. Diabetes is characterized by an increase in the activity of plasma clotting factors (I, II, III, VII, VIII, IX, XI, XII and XIII), activation of the callicrein-kinin system. In some cases, this correlates with the development of complications of diabetes. Characteristic disorders in the coagulation inhibition system are a decrease in the activity of antithrombin III, reduced formation of thrombin-antithrombin complexes, reduction of thrombomodulin and protein C. In diabetes, there is a decrease in fibrinolysis, due to a decrease in the expression of tissue activator plasminogen and an increase in the level of the inhibitor of the activator plasminogen. The possibilities of drug correction of hypercoagulation factors in diabetes are to achieve glycemic control with sugar-reducing drugs and elimination of dyslipidemia through hypolipidemic therapy. The most well-studied sugar-lowering drug that improves the state of the blood clotting system is metformin. The system of hemostasis in diabetic patients is positively affected by statins both due to the direct hypolipidemic effect, and by improving endothelial function and increasing fibrinolysis.

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Antiplatelet therapy use in diabetes mellitus patients: modern approaches and ischemic heart disease prevention perspectives

Cited by 2 publications

References 0 publications

Management of ischemic risk events in patients with multifocal atherosclerosis and type 2 diabetes mellitus

Management of ischemic risk events in patients with multifocal atherosclerosis and type 2 diabetes mellitus

The main pathogenetic mechanisms of hypercoagulation in diabetes and the possibility of its drug correction

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