Challenges and Perspectives of Antiplatelet Therapy in Patients with Diabetes Mellitus and Coronary Artery Disease

Patients with diabetes mellitus (DM) have accelerated atherosclerosis, which explains their high risk of cardiovascular disease and atherothrombotic complications. Among the several factors contributing to the prothrombotic condition which characterize patients with DM, platelet hyperreactivity is of major relevance since platelets play a key role in the development of atherosclerosis and its atherothrombotic complications. A number of mechanisms contribute to platelet dysfunction and affect the adhesion, activation and, aggregation phases of platelet-mediated thrombosis. In addition, DM is associated with a high prevalence of reduced pharmacodynamic response to standard oral antiplatelet treatment regimens. The latter may contribute to explain the fact that despite the use of recommended antiplatelet treatment strategies, the presence of DM has been consistently associated with a high rate of adverse recurrent cardiovascular events. Therefore, several new antiplatelet treatment strategies have been developed in order to optimize platelet inhibition: a) modification of dosing of commonly used agents; b) use of new agents; and c) addition of a third antiplatelet drug (triple therapy). The present review manuscript aims to provide an overview on the current status of knowledge on platelet abnormalities that characterize patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population.