Diabetes mellitus and resistance to therapy with ADP-receptor antagonists: Importance, possibilities of detection and therapeutic influence
Authors:
Matej Samoš; Tomáš Bolek; František Kovář; Peter Galajda; Marián Mokáň
Authors‘ workplace:
I. interná klinika, Jesseniova LF UK a UNM, Martin
Published in:
AtheroRev 2018; 3(1): 34-39
Category:
Reviews
Overview
Diabetes mellitus is connected with clopidogrel resistance, an independent risk factor of future ischemic events in patients undergoing percutaneous coronary interventions, including stent thrombosis. On-treatment platelet reactivity assessment should be considered especially in clopidogrel-treated DM patients. Platelet function testing might be performed either with nonspecific methods, such as light transmission aggregometry as a golden standard, or with a specific method – VASP (vasodilator stimulated phosphoprotein) phosphorylation assessment. New ADP-receptor blockers – prasugrel and ticagrelor – seem to be more effective for overcoming clopidogrel resistance in diabetic patients. These agents both show rapid and consistent platelet inhibition. Tailored clopidogrel therapy may be considered in selected cases; however, this strategy has lower evidence from clinical trials. The therapeutic goal is to achieve sufficient inhibition of ADP-signaling pathway, which will reduce the risk of future serious ischemic events.
Key words:
ADP-receptor blockers, aggregometry, clopidogrel, clopidogrel resistance, diabetes mellitus, phosphorylation VASP, prasugrel, ticagrelor
Received:
30. 12. 2017
Accepted:
29. 1. 2018
Sources
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