Abstract
In type 2 diabetes, anti-thrombotic management is challenging, and current anti-platelet agents have demonstrated reduced efficacy. Old and new anti-diabetic drugs exhibited—besides lowering blood glucose levels—direct and indirect effects on platelet function and on thrombotic milieu, eventually conditioning cardiovascular outcomes. The present review summarizes existing evidence on the effects of glucose-lowering agents on platelet properties, addressing pre-clinical and clinical research, as well as drug–drug interactions with anti-platelet agents. We aimed at expanding clinicians’ understanding by highlighting new opportunities for an optimal management of patients with diabetes and cardiovascular disease. We suggest how an improvement of the thrombotic risk in this large population of patients may be achieved by a careful and tailored combination of anti-diabetic and anti-platelet therapies.
Highlights
Type 2 Diabetes (T2D) represents a critical risk factor for cardiovascular disease (CVD)
Hyperglycemia has been reported to significantly affect the expression of several platelet and circulating microRNAs in diabetic patients; these small, non-coding RNA molecules have a central role in the modulation of platelet activity and represent potential biomarkers to investigate the response to specific anti-platelet treatments (Carino et al, 2016; Pordzik et al, 2019)
These data suggest that postprandial hyperinsulinemia, rather than postprandial hyperglycemia, causes platelet hyperactivity mediated via pathways stimulated by TXB and adenosine diphosphate (ADP) but not collagen in patients with T2D
Summary
Type 2 Diabetes (T2D) represents a critical risk factor for cardiovascular disease (CVD). Platelet dysfunction plays a central role in building up the cardiovascular risk of diabetic patients, since T2D is characterized by an enhanced thrombotic state related to endothelial dysfunction, activation of the coagulation cascade and increased platelet reactivity (Murcia et al, 2004; Gæde et al, 2003; Gresele et al, 2010; Nusca et al, 2019) The pathophysiology underlying such abnormal platelet response has been largely investigated. The potential benefit on platelets may be related to the normalization of glycemic control, but other additional direct antithrombotic and anti-inflammatory mechanisms may be involved These findings are clinically relevant since the modulation of platelet activation by anti-diabetic drugs may mitigate the risk of thrombotic events and contribute to cardiovascular protection in diabetic patients (Figure 1). The American Diabetes Association recommends metformin as first-line therapy for T2D in newly diagnosed cases and it is the most widely used anti-diabetic drug
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
