Inhibition of platelet aggregation in diabetic patients

Major cardiovascular complications and ischemic events occur more frequentl y in diabetic than nondiabetic patients. Platelets of diabetic patients are found in a permanent prethrombotic state. Platelet activation and aggregat ion with resultant arterial thrombus formation, are the central mechanisms in the pathophysiology of acute coronary syndromes. Over the past two decad es aspirin was the leading antithrombotic agent for reduction of thrombotic events and efficacy was proven in many studies. The main study concerning the aspirin question was the "Antiplatelet Trialist's Collaboration-Study", where a successful risk reduction for vascular events of 25 % - 34 % was o bserved with daily dosis between 75 and 325 mg. In the last years some new, very effective drugs have been developed. Clopidogrel, a thienopyridine wa s studied in the CAPRIE trial and compared with aspirin. A small advantage could be proved for clopidogrel. The development of inhibitors of fibrinoge n, binding to the platelet glykoprotein IIb/IIIa receptor has expanded the therapeutic spectrum for the treatment of thrombotic disorders. Especially in diabetic patients a significant benefit of these new drugs was demonstra ted in Various clinical indications. The newest results show the clear adva ntage of combining thrombolytic agents with the glycoprotein Ilb/IIIa recep tor antagonists in reperfusion after myocardial infarction. In conclusion t he main message is, that diabetic patients do need antithrombotic therapy e arlier than nondiabetic patients, that efficient drugs are available and th at a primary prevention should be considered in this special patient group.