Patient with diabetes after acute coronary event. How to improve forecast?

Abstract

Patients with diabetes mellitus are characterized by a higher risk of developing atherothrombotic events than patients without diabetes. One of the reasons for this is the high reactivity and rate of platelet metabolism. The role of aspirin in the prevention of cardiovascular events in patients with diabetes without a history of atherothrombotic events is unclear. In patients with a history of thromboischemic events, aspirin is useful for cardiovascular prophylaxis. Available data suggest that patients with diabetes and acute coronary syndrome (ACS) will benefit more from using more aggressive antiplatelet drugs than clopidogrel (in addition to aspirin), which will reduce the ischemic risk for patients with diabetes of equal or greater degree compared with patients without diabetes. These drugs include ticagrelor (in patients with ACS, regardless of the initial treatment strategy) and prasugrel (in patients with an invasive treatment strategy). For patients with diabetes, high ischemic and low hemorrhagic risks, prolonging double antiplatelet therapy for more than a year with a reduced dose of ticagrelor (60 mg twice a day) can be accompanied by a decrease in ischemic risk.