Resistance to antiplatelet drugs in patients with cardiovascular diseases and diabetes
Journal Title: Postępy Nauk Medycznych - Year 2013, Vol 26, Issue 3
Abstract
Treatment with antiplatelet drugs – aspirin (ASA) and clopidogrel – is a standard procedure in patients with cardiovascular disease, especially after ACS and invasive treatment. Despite this, cardiac events, including premature restenosis, occur in a number of patients. Such complications are partially ascribed to resistance to aspirin and/or clopidogrel. This phenomenon results in high on treatment platelet reactivity (HTPR) which seems to be more pronounced in patients with diabetes. There are several mechanism which may play a role in diabetic patients such as glycation of platelet proteins, increased platelet turnover, insulin resistance, oxidative stress, reduced bioavailability of the drugs or their metabolites. The frequency of cardiac events is associated with laboratory determined HTPR and cannot be significantly reduced by increasing doses of aspirin and clopidogrel. The way to overcome resistance to the above medicines is to use new antiplatelet drugs. Prasugrel and ticagrelor proved to be more effective than clopidogrel in reducing cardiac events in patients treated with PCI. These drugs are approved by ESC and AHA for treatment of ACS patients (with few exceptions e.g. excessive risk of major bleeding). Prasugrel appears to be especially effective in patients with diabetes. Triple antiplatelet therapy (with cilostazol added to ASA and clopidogrel) seems to offer some additional benefit in patients with diabetes but results of available studies are equivocal.
Authors and Affiliations
Wiesław Piechota
Keywords
Related Articles
- EP ID EP54687
- DOI -
- Views 102
- Downloads 0
Pregnancy in women with valvular heart disease
Pregnancy creates significant hemodynamic changes in the cardiovascular system following the hormonal changes and the impact of placental circulation. Coexisting valvular heart disease increases substantially and, althou...
Waist-to-Height Ratio – an Alternative Index for Evaluating Obesity and Assessing the Cardio-Metabolic Risk. A Study in Warsaw Adolescents
Introduction. Overweight and obesity are well-established causes of increased metabolic and cardio-vascular risk, also in children and adolescents. Since the adverse effects of excess adiposity are believed to be mostly...
The usefulness of natrium concentrations in the evaluation of indications for hospitalization in children with pneumonia
Introduction. Community-acquired pneumonia (CAP) is an important health concern that often requires hospitalization, especially in children under five years of age. Among indications for hospital treatment, Polish recomm...
Zespoły mielodysplastyczne – współczesna diagnostyka, klasyfikacja i leczenie Część I: Diagnostyka, klasyfikacja i stratyfikacja prognostyczna zespołów mielodysplastycznych
Zespoły mielodysplastyczne są heterogenną grupą nabytych klonalnych chorób krwiotwórczej komórki macierzystej, charakteryzujących się nieefektywną hematopoezą, opornymi cytopeniami i zwiększonym ryzykiem transformacji do...
Powikłania naczyniowe po zabiegach kardiologii interwencyjnej – diagnostyka i postępowanie
Nakłucie tętnicy związane jest z ryzykiem krwawienia i powikłań miejscowych, dlatego zabieg ten może być wykonywany tylko przez lekarzy. Powikłania naczyniowe są istotnym problemem współczesnej kardiologii inwazyjnej. Wi...