Antiplatelet Therapy for Patients with Diabetes: More Is Better

In patients with ACS, the net clinical benefit of prasugrel, compared with clopidogrel, was greater for those who had diabetes than for those who didn’t.

Prasugrel is an investigational thienopyridine antiplatelet agent. In the TRITON-TIMI 38 study involving patients with acute coronary syndromes scheduled for percutaneous coronary intervention, prasugrel produced a greater reduction in adverse cardiovascular events — but also more bleeding events —than did clopidogrel (JW Cardiol Nov 4 2007). Because diabetes increases platelet reactivity and clopidogrel resistance rates, the TRITON-TIMI 38 investigators conducted a prespecified analysis of prasugrel’s effects in diabetic and nondiabetic participants.

Among 13,608 subjects, 23% had diabetes, and 6% required insulin. The diabetic patients were older, more often women, and more likely to have unstable angina or non-ST-elevation MI (vs. STEMI) …

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)