糖尿病ACS患者抗血小板治疗PPT.ppt

Altered platelet functions in diabetes Diabetic thrombocytopathy refers to differences in platelet function between diabetic and nondiabetic individuals. Both diabetic and prediabetic conditions are associated with platelet and coagulation derangements. Increased platelet aggregability and adhesiveness in diabetes is due to a series of alterations in platelet functions. Because of the importance of platelet aggregation in thrombus formation, treatment strategies have focused on using antiplatelet agents to prevent recurrent events. Summary The objective was to describe the indices of platelet aggregation and activation in a large cohort of diabetic patients with coronary artery disease (CAD). Recently, a number of observations have indicated that patients with diabetes mellitus (DM) exhibit persistent platelet activation,and low response after antiplatelet therapy, although no randomized data exist.We sought to define the baseline platelet biomarkers,and the patterns of response to aspirin and clopidogrel therapy in DM versus non-diabetic patients. Secondary post-hoc analyses were made of platelet activity biomarkers in the dataset which consisted of patients with documented CAD (n=822), including those with DM (n=257). Patients with DM exhibited higher baseline platelet activity by adenosine diphosphate (ADP)- (p=0.0002), and collagen-induced (p=0.03) aggregometry; Ultegra- (p=0.0001), and PFA-100 (p=0.02) analyzers; and expression of platelet/en-dothelial cell adhesion molecule-1 (PECAM-1) (p=0.01), glycoprotein (GP) IIb/IIIa antigen (p=0.001), and activity (p=0.02), vitronectin receptor (p=0.03), P selectin (p=0.02), and intact epitope of PAR-1 thrombin receptor (p=0.02). Antiplatelet response after clopidogrel in diabetics was impaired when compared with non-diabetics. In conclusion, diabetic patients exhibit high pretreatment platelet activity, and do not respond well to the available antiplatelet regimens when compared with similar patients without DM.The