Lookup NU author(s): Dr Girish Viswanathan,
Professor Sally Marshall,
Dr Karthik Balasubramaniam,
Professor Azfar Zaman
Full text for this publication is not currently held within this repository. Alternative links are provided below where available.
Type 2 diabetes mellitus (T2DM) is associated with higher rates of thrombotic complications in patients with coronary artery disease (CAD) despite optimal medical therapy. Thrombus area was measured in T2DM and non-diabetic patients receiving aspirin and clopidogrel 7-10 days after troponin positive Non ST-elevation acute coronary syndrome (NSTE-ACS). Secondly, we assessed response to clopidogrel in naive patients with T2DM and stable CAD in a randomised controlled trial. Thrombus area was measured by Badimon chamber and platelet reactivity by VerifyNow (R). In T2DM patients presenting with NSTE-ACS, thrombus area was greater compared to non-diabetic patients (mean +/- SD, 20,512 +/- 12,567 [n=40] vs. 14,769 +/- 8,531 [n=40] mu m(2)/mm, p=0.02) Clopidogrel decreased thrombus area among stable CAD patients with T2DM (mean +/- SD, Clopidogrel [n=45]: 13,978 +/- 5,502 to 11,192 +/- 3,764 mu m(2)/mm vs. placebo [n=45]: 13,959 +/- 7,038 to 14,201 +/- 6,780 mu m(2)/mm, p<0.001, delta values: clopidogrel vs. placebo, mean +/- SD, 2,786 +/- 4,561 vs. -249 +/- 2,478, p<0.0005). Only 44% of patients with CAD and T2DM responded to clopidogrel as per VerifyNow (R) (cut-off PRUz value of >= 240). Importantly, no correlation was observed between thrombus area and VerifyNow (R) values (rho 0.08, 13=0.49). Thrombus area values were similar among hypo-responders and good responders to clopidogrel (mean thrombus area +/- SD: 12,186 +/- 4,294 vs. 10,438 +/- 3,401; p=0.17). Type 2 diabetes mellitus is associated with an increased blood thrombogenicity among NSTE-ACS patients on currently recommended medical therapy. Thrombus area was significantly reduced in all stable CAD patients independently of their response to clopidogrel therapy.
Author(s): Viswanathan GN, Marshall SM, Schechter CB, Balasubramaniam K, Badimon JJ, Zaman AG
Publication type: Article
Publication status: Published
Journal: Thrombosis and Haemostasis
Print publication date: 01/11/2012
ISSN (print): 0340-6245
Publisher: Schattauer GmbH
Altmetrics provided by Altmetric