The relation between platelet reactivity and glycemic control in diabetic patients with cardiovascular disease on maintenance aspirin and clopidogrel therapy

Resistência ao clopidogrel: prevalência e variáveis associadas

“…Within the diabetic population, some studies show that glycemic control, in most of them measured by glycosylated hemoglobin, has an even more deleterious effect on the antiplatelet therapy profile than the disease itself 22,23 . Angiolillo et al 24 showed that in diabetic patients receiving dual antiplatelet therapy, a high value of platelet aggregation increases the risk of major cardiac events (OR = 3.96 95% CI: 1.8 -8.7).…”

Assessment of platelet function by whole blood impedance aggregometry in coronary artery bypass grafting patients on acetylsalicylic acid treatment may prompt a switch to dual antiplatelet therapy

“…Higher prevalence of RPR described in our diabetic patients' subgroup might be a major contributor to poorer outcomes among diabetic patients. It has been recently reported that platelet reactivity is tightly associated with glycemic control in diabetics [29]. Elevated glycosylated hemoglobin levels are common among diabetic patients scheduled for coronary surgery, particularly in patients receiving insulin, and are associated with more frequent occurrence of perioperative myocardial infarction [30].…”

Review article: Antithrombotic therapy in patients with diabetes mellitus and coronary artery disease

“…12,14,15,92 Of note, DM patients with poor metabolic control and those who require insulin therapy have the worst response to clopidogrel in patients on dual antiplatelet therapy (Figure 2). 93,94 In addition, patients with DM are at a higher risk of developing chronic kidney disease (CKD), which impairs response to antiplatelet agents and is a risk factor per se of worse clinical outcomes. Among DM patients, the presence of moderate to severe CKD is associated with decreased response to clopidogrel, 95 which is in line with the results of a post hoc analysis of the CHARISMA trial, which suggests that clopidogrel use might increase adverse outcomes in patients with diabetic nephropathy.…”