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 118
- Downloads 0
Vitamin D and rheumatoid arthritis
Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic pain and impairment of joints as well as progressive disability. RA affects 0,5-1% of adults in developed countries. The disease is three times...
Akwafereza w leczeniu zaostrzenia przewlekłej niewydolności serca – uzasadnienie i początkowe doświadczenia kliniczne jednego ośrodka
Kolejnych 20 pacjentów z opornym na diuretyki zaostrzeniem przewlekłej niewydolności serca poddano 1-11 sesji izolowanej ultrafiltracji. W przypadku, gdy pojawiały się biochemiczne wskazania do lecznia nerkozastępczego,...
Current therapeutic options in children with hypertrophic cardiomyopathy – own experience
Introduction. The clinical course of hypertrophic cardiomyopathy (HCM) in children is very heterogeneous. In some children, the thickened heart muscle causes progressive heart failure and life-threatening arrhythmias. HC...
Plethoric facies – multidisciplinary problem. Histamine intolerance secondary to reduced diamine oxydase activity
A 70-year-old woman with plethoric and burning cheeks was diagnosed in Department of Endocrinology with suspicion of carcinoid syndrome a few years ago. From time to time she had headache, stomach ache and arthralgia. Be...
Intramedullary fixation in the treatment multi-level<br /> and comminuted tibia fractures
Fractures within crus may happen among patients of all ages and they are one of the most common fractures. Taking into consideration the structure of tibia, one of the strongest bones in human body, fractures are a resul...