Uso de antiaqreqantes en la diabetes

Abstract

The hypercoagulability state present in people with diabetes may contribute to the greater atherosclerotic involvement observed in these patients. Therefore, the use of antiaggregants, besides treatment for other cardiovascular risk factors, seems to be rational in the therapeutic strategy for these patients. Current evidences justify the use of antiaggregants in secondary prevention, although with reduced efficacy in people with diabetes as compared with the general population, probably due to a certain resistance to aspirin effects. Aspirin in primary prevention has been controversial, mainly among the American diabetologists and cardiologists (ADA, AHA) favorable to its use in contrast with the European societies (EASD, ESC) against the use of antiaggregants in this context. The Americans support their position assuming that people with diabetes have a similar risk to those who have had an acute myocardial infarction, while the European opinion is based on the lack of scientific evidence demonstrating the benefit of treatment with aspirin, particularly considering the undesirable effects of this drug. Recent studies seem to support the latter position. Therefore, the use of aspirin in primary prevention is probably only indicated at low doses when numerous cardiovascular risk factors exist, consequently when possible benefits overcome potential risks.