Rivas Rios Jose R, Franchi Francesco, Rollini Fabiana, Angiolillo Dominick J
Division of Cardiology, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA.
Cardiovasc Diagn Ther. 2018 Oct;8(5):594-609. doi: 10.21037/cdt.2018.05.09.
Diabetes mellitus (DM) is a metabolic disorder associated with accelerated atherogenesis and an increased risk of atherothrombotic complications. Multiple mechanisms contribute to the pro-thrombotic status which characterizes DM patients underscoring the importance of antiplatelet therapies used for secondary prevention in these patients. For many years, dual antiplatelet therapy (DAPT) with aspirin and the P2Y inhibitor clopidogrel has represented the mainstay of treatment following an acute coronary syndrome (ACS) or in patients undergoing percutaneous coronary interventions (PCI). Although DAPT reduces the incidence of atherothrombotic recurrences, these rates remain high in DM patients underscoring the need for more efficacious therapies. Oral platelet P2Y receptor inhibitors with enhanced potency, such as prasugrel and ticagrelor, as well as antiplatelet therapies such as vorapaxar inhibiting the thrombin-mediated platelet signaling pathway, constitute treatment opportunities for patients with DM and have shown to be associated with a greater reduction in ischemic recurrences, albeit at the cost of more bleeding. This article reviews currently available antiplatelet agents and delivers an update on the advances and drawbacks of these agents used for secondary prevention in DM patients experiencing an ACS or undergoing PCI.
糖尿病（DM）是一种与动脉粥样硬化加速和动脉粥样血栓形成并发症风险增加相关的代谢紊乱疾病。多种机制导致了DM患者所具有的促血栓形成状态，这突出了抗血小板治疗在这些患者二级预防中的重要性。多年来，阿司匹林和P2Y抑制剂氯吡格雷的双联抗血小板治疗（DAPT）一直是急性冠状动脉综合征（ACS）后或接受经皮冠状动脉介入治疗（PCI）患者的主要治疗方法。尽管DAPT降低了动脉粥样血栓形成复发的发生率，但在DM患者中这些发生率仍然很高，这突出了对更有效治疗方法的需求。效力增强的口服血小板P2Y受体抑制剂，如普拉格雷和替格瑞洛，以及抑制凝血酶介导的血小板信号通路的抗血小板治疗药物沃拉帕沙，为DM患者提供了治疗机会，并已显示出与缺血性复发的更大程度降低相关，尽管代价是更多的出血。本文综述了目前可用的抗血小板药物，并介绍了这些药物在经历ACS或接受PCI的DM患者二级预防中的进展和缺点。
