Tufano A, Cimino E, Di Minno M N D, Ieranò P, Marrone E, Strazzullo A, Di Minno G, Cerbone A M
Regional Reference Centre for Coagulation Disorders, Department of Clinical and Experimental Medicine, University of Naples Federico II, 80131 Naples, Italy.
Int J Vasc Med. 2011;2011:250518. doi: 10.1155/2011/250518. Epub 2011 Jun 30.
Diabetes mellitus (DM) is associated with macrovascular and microvascular complications. Platelets have a "key role" in atherogenesis and its thrombotic complications in subjects with DM. Moreover, the concomitant presence of multiple "classical" cardiovascular risk factors in diabetic subjects contributes to enhanced atherothrombotic risk. Antiplatelet agents are effective in primary and secondary prevention of arterial thrombosis (cardiovascular events, ischaemic stroke, and peripheral arterial occlusive disease). The role of chronic administration of antiplatelet drugs in primary prevention of arterial vascular events is known to be less clear than in secondary prevention, and, also in diabetic patients, the decision to give primary prophylaxis should be taken on an individual-patient basis, after a careful evaluation of the balance between the expected benefits and the risk of major bleedings. Although, currently, treatment has proven useful in reducing vascular events, diabetic patients continue to have a higher risk of adverse cardiovascular events compared with those in nondiabetic patients. This paper reviews the role of currently available antiplatelet drugs in primary and secondary prevention of vascular events in diabetic patients and the limitations of these drugs, and it discusses the role of novel and more potent antiplatelets and of new agents currently under clinical development.
糖尿病（DM）与大血管和微血管并发症相关。在糖尿病患者中，血小板在动脉粥样硬化及其血栓形成并发症中起“关键作用”。此外，糖尿病患者同时存在多种“经典”心血管危险因素会增加动脉粥样硬化血栓形成风险。抗血小板药物在动脉血栓形成（心血管事件、缺血性中风和外周动脉闭塞性疾病）的一级和二级预防中有效。长期使用抗血小板药物在动脉血管事件一级预防中的作用不如二级预防明确，而且，即使在糖尿病患者中，给予一级预防的决定也应在仔细评估预期获益与大出血风险之间的平衡后，根据个体患者情况做出。虽然目前治疗已被证明有助于减少血管事件，但与非糖尿病患者相比，糖尿病患者发生不良心血管事件的风险仍然更高。本文综述了目前可用的抗血小板药物在糖尿病患者血管事件一级和二级预防中的作用以及这些药物的局限性，并讨论了新型、更有效的抗血小板药物和目前正在临床开发的新药的作用。
