Antithrombotic therapy in diabetes : which, when, and for how long?
Ajjan, Ramzi A. (The LIGHT Laboratories, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds)
Kietsiriroje, Noppadol (Prince of Songkla University)
Badimon, Lina (Institut d'Investigació Biomèdica Sant Pau)
Vilahur, Gemma (Institut d'Investigació Biomèdica Sant Pau)
Gorog, Diana A. (National Heart and Lung Institute, Dovehouse St)
Angiolillo, Dominick J. (University of Florida)
Russell, David A. (Leeds Vascular Institute)
Rocca, Bianca (Catholic University School of Medicine, Rome)
Storey, Robert F. (University of Sheffield)
Universitat Autònoma de Barcelona

Fecha:	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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article de revisió ; recerca ; Versió publicada
Materia:	Diabetes ; Cardiovascular ; Cerebrovascular ; Peripheral artery disease ; Antithrombotic ; Antiplatelet
Publicado en:	European heart journal, Vol. 42 (march 2021) , p. 2235-2259, ISSN 1522-9645

DOI: 10.1093/eurheartj/ehab128
PMID: 33764414

25 p, 1.2 MB

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