Managing thrombotic risk in patients with diabetes

Abstract

It is well known that diabetes is a prominent risk factor for cardiovascular (CV) events. The level of CV risk depends on the type and duration of diabetes, age and additional co-morbidities. Diabetes is an independent risk factor for atrial fibrillation (AF) and is frequently observed in patients with AF, which further increases their risk of stroke associated with this cardiac arrhythmia. Nearly one third of patients with diabetes globally have CV disease (CVD). Additionally, co-morbid AF and coronary artery disease are more frequently observed in patients with diabetes than the general population, further increasing the already high CV risk of these patients. To protect against thromboembolic events in patients with diabetes and AF or established CVD, guidelines recommend optimal CV risk factor control, including oral anticoagulation treatment. However, patients with diabetes exist in a prothrombotic and inflammatory state. Greater clinical benefit may therefore be seen with the use of stronger antithrombotic agents or innovative drug combinations in high-risk patients with diabetes, such as those who have concomitant AF or established CVD. In this review, we discuss CV risk management strategies in patients with diabetes and concomitant vascular disease, stroke prevention regimens in patients with diabetes and AF and how worsening renal function in these patients may complicate these approaches. Accumulating evidence from clinical trials and real-world evidence show a benefit to the administration of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with diabetes and AF.

Endothelial biomarkers and platelet reactivity on ticagrelor versus clopidogrel in patients after acute coronary syndrome with and without concomitant type 2 diabetes: a preliminary observational study

“…Additionally, in the PEGASUS-TIMI 54 trial benefits of prolonged DAPT including low-dose ticagrelor in high-risk patients with prior myocardial infarction 1–3 years earlier were shown [ 4 ]. Although relative clinical benefits of ticagrelor in these trials were consistent irrespective of diabetes status [ 3 , 4 ], absolute risk reduction was greater in patients with coexistent diabetes [ 5 , 6 ], known to associate with a higher risk of ischemic events via a corollary of mechanisms, including prothrombotic pathways [ 7 , 8 ]. Moreover, in a GReek AntiPlatElet registry substudy, DAPT with newer P2Y 12 antagonists, but not clopidogrel, attenuated the negative impact of diabetes on ischemic CV events after ACS [ 9 ].…”

Only Subclinical Alterations in the Haemostatic System of People with Diabetes after COVID-19 Vaccination

“…This is of particular interest, as people with diabetes are already at increased risk of thromboembolic events. [ 7 , 19 , 20 ]…”

“…While the benefit–risk profile of these COVID-19 vaccines is clearly in favour of the vaccination, the impact on the coagulation system, particularly in people already at increased risk of atherothrombotic events, such as those with manifest diabetes mellitus, deserves further investigation [ 7 ].…”

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“…Diabetes mellitus and hypertension are common co-morbidities that increase the risk of atherosclerosis and associated consequences, such as heart attacks and strokes [1]. The increased body fat levels are linked to an increased risk of metabolic disorders such as type 2 diabetes, hypertension, and dyslipidemia [2].…”