Antithrombotic therapy in diabetes: which, when, and for how long?
Por:
Ajjan, RA, Kietsiriroje, N, Badimon, L, Vilahur, G, Gorog, DA, Angiolillo, DJ, Russell, DA, Rocca, B, Storey, RF
Publicada:
14 jun 2021
Ahead of Print:
1 mar 2021
Resumen:
Cardiovascular disease remains the main cause of mortality in individuals with diabetes mellitus (DM) and also results in significant morbidity. Premature and more aggressive atherosclerotic disease, coupled with an enhanced thrombotic environment, contributes to the high vascular risk in individuals with DM. This prothrombotic milieu is due to increased platelet activity together with impaired fibrinolysis secondary to quantitative and qualitative changes in coagulation factors. However, management strategies to reduce thrombosis risk remain largely similar in individuals with and without DM. The current review covers the latest in the field of antithrombotic management in DM. The role of primary vascular prevention is discussed together with options for secondary prevention following an ischaemic event in different clinical scenarios including coronary, cerebrovascular, and peripheral artery diseases. Antiplatelet therapy combinations as well as combination of antiplatelet and anticoagulant agents are examined in both the acute phase and long term, including management of individuals with sinus rhythm and those with atrial fibrillation.
The difficulties in tailoring therapy according to the variable atherothrombotic risk in different individuals are emphasized, in addition to the varying risk within an individual secondary to DM duration, presence of complications and predisposition to bleeding events. This review provides the reader with an up-to-date guide for antithrombotic management of individuals with DM and highlights gaps in knowledge that represent areas for future research, aiming to improve clinical outcome in this high-risk population.
[GRAPHICS]
.
Filiaciones:
Ajjan, RA:
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds LS2 7JT, W Yorkshire, England
Kietsiriroje, N:
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds LS2 7JT, W Yorkshire, England
Prince Songkla Univ, Fac Med, Internal Med Dept, Endocrinol & Metab Unit, Hat Yai 90110, Thailand
Badimon, L:
IIB St Pau, Cardiovasc Program ICCC, Res Inst Hosp Santa Creu & St Pau, St Antoni M Claret 167, Barcelona 08025, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Cardiovasc CIBERCV, St Antoni M Claret 167, Barcelona 08025, Spain
Univ Autonoma Barcelona UAB, Cardiovasc Res Chair, St Antoni M Claret 167, Barcelona 08025, Spain
Vilahur, G:
IIB St Pau, Cardiovasc Program ICCC, Res Inst Hosp Santa Creu & St Pau, St Antoni M Claret 167, Barcelona 08025, Spain
Inst Salud Carlos III, Ctr Invest Biomed Red Cardiovasc CIBERCV, St Antoni M Claret 167, Barcelona 08025, Spain
Gorog, DA:
Univ Hertfordshire, Coll Lane Campus Hatfield, Hatfield AL10 9AB, Herts, England
Natl Heart & Lung Inst, Guy Scadding Bldg,Dovehouse St, London SW3 6LY, England
Angiolillo, DJ:
Univ Florida, Div Cardiol, Coll Med Jacksonville, 655 West,8th St, Jacksonville, FL 32209 USA
Russell, DA:
Univ Leeds, Leeds Inst Cardiovasc & Metab Med, Leeds LS2 7JT, W Yorkshire, England
Leeds Gen Infirm, Leeds Vasc Inst, Great George St, Leeds LS1 3EX, W Yorkshire, England
Rocca, B:
Catholic Univ, Inst Pharmacol, Sch Med, Rome, Italy
Storey, RF:
Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Beech Hill Rd, Sheffield S10 2RX, S Yorkshire, England
hybrid, Green Published
|