ANTITHROMBOTICS AND DIABETES - BENEFITS A ND RECOMMENDATIONS OF USAGE

Diabetic patients (3 % of the French population) have a higher risk of coronary and peripheral vascular disease than non-diabetic subjects a nd develop long-term microvascular renal and retinal complications. Ab normalities of coagulation, haemostasis and fibrinolysis have been dem onstrated in diabetics and contribute to these complications. The pres cription of antithrombotics is therefore common in these patients. Pla telet antiaggregants (aspirin and ticlopidine) are effective in primar y and secondary prevention in reducing the overall number of vascular events (reduction of 17 % in the last ATC meta-analysis) and of corona ry and cerebrovascular complications in particular. Two studies have s hown a preventive effect of antiaggregants on diabetic retinopathy in its initial stages. With regards to the value of the use of these agen ts, there are few complications which may be limited by appropriate me asures. One problem lies in the choice of aspirin dosage, most studies having been performed with high doses ranging from 500 to 1 300 mg pe r 24 hours. It is therefore difficult to recommend doses less than 300 to 500 mg per 24 hours. The prescription of anticoagulants (heparin, vitamin-K antagonists) is not associated with more problems in diabeti cs than in non-diabetics. The same applies to the use of thrombolytics in the acute phase of myocardial infarction : the risk of haemorrhage s, especially intraocular, is only theoretical, only one case (regress ive) having been reported to date. In conclusion, diabetes is more a p riviledged indication than a contra-indication to the use of antithrom botic, platelet inhibitor, anticoagulant and thrombolytic agents.