[Acetylsalicylic acid in patients with diabetes mellitus: can be used for secondary but not primary prevention of cardiovascular events].

There is no consensus in international guidelines about the role of acetylsalicylic acid in primary prevention of cardiovascular events in patients with diabetes mellitus.Primary prevention trials suggest that in diabetic patients, acetylsalicylic acid has either no or less favourable effects in preventing cardiovascular events compared to patients with other cardiovascular risk factors.Increased platelet activity, increased activation of clotting factors and interaction between glycation and acetylation are the most plausible explanations for this loss of efficacy in patients with diabetes mellitus.The evidence for the use of alternative antiplatelet therapy in addition or instead of acetylsalicylic acid is too limited to recommend this as an alternative preventive method. Also increasing the dose of acetylsalicylic acid is probably not worthwhile.We do not recommend acetylsalicylic acid as primary prevention of cardiovascular events in patients with diabetes mellitus, but we do recommend it as a means of secondary prevention.