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Thrombus and antiplatelet therapy in type 2 diabetes mellitus: A prospective study after non-ST elevation acute coronary syndrome and a randomised, blinded, placebo-controlled study in stable angina

Lookup NU author(s): Dr Girish Viswanathan, Emerita Professor Sally Marshall, Dr Karthik Balasubramaniam, Professor Azfar Zaman

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Abstract

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.

Publication metadata

Author(s): Viswanathan GN, Marshall SM, Schechter CB, Balasubramaniam K, Badimon JJ, Zaman AG

Publication type: Article

Publication status: Published

Journal: Thrombosis and Haemostasis

Year: 2012

Volume: 108

Issue: 5

Pages: 937-945

Print publication date: 01/11/2012

ISSN (print): 0340-6245

ISSN (electronic):

Publisher: Schattauer GmbH

URL: http://dx.doi.org/10.1160/TH12-06-0408

DOI: 10.1160/TH12-06-0408

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