Additionally, net clinical benefits of ticagrelor plus aspirin compared to aspirin alone were reported in participants of the THEMIS-PCI trial with type 2 diabetes (T2DM) and stable coronary artery disease (CAD) with a history of previous percutaneous coronary intervention (PCI) but without prior myocardial infarction or stroke, regardless of diabetes duration or glycated hemoglobin levels. Moreover, in a GReek AntiPlatElet registry substudy, DAPT with newer P2Y 12 antagonists, but not clopidogrel, attenuated the negative impact of diabetes on ischemic CV events after ACS. Although relative clinical benefits of ticagrelor in these trials were consistent irrespective of diabetes status, absolute risk reduction was greater in patients with coexistent diabetes, known to associate with a higher risk of ischemic events via a corollary of mechanisms, including prothrombotic pathways. Additionally, in the PEGASUS-TIMI 54 trial benefits of prolonged DAPT including low-dose ticagrelor in high-risk patients with prior myocardial infarction 1–3 years earlier were shown. īeneficial clinical effects of ticagrelor compared to clopidogrel were first demonstrated in the PLATO trial, where ticagrelor was associated with a lower risk of myocardial infarction, cardiovascular (CV) and all-cause death as well as stent thrombosis over a median follow-up of 9 months regardless of ACS type or treatment strategy. In addition to low-dose aspirin, potent P2Y 12 antagonists, ticagrelor and prasugrel, are preferred over clopidogrel in post-ACS patients, whereas clopidogrel is recommended only if ticagrelor and prasugrel are unavailable, not tolerated or contraindicated, e.g. If proven, this could contribute to more pronounced clinical benefits of ticagrelor in diabetic subjects.ĭual antiplatelet therapy (DAPT) is a standard of care in patients after acute coronary syndromes (ACS) and/or after coronary stent implantation. Our preliminary findings may suggest an association of ticagrelor-based maintenance DAPT with favorable endothelial effects compared to clopidogrel users in stable post-ACS patients with T2DM. Platelet reactivity was unrelated to any endothelial biomarker in subjects with or without T2DM. The concentrations of sE-selectin, monocyte chemoattractant protein-1 and asymmetric dimethylarginine did not differ according to the type of P2Y 12 antagonist regardless of T2DM status. Exclusion criteria included a complicated in-hospital course, symptomatic heart failure, left ventricular ejection fraction 0.7). Methodsīiochemical indices of endothelial dysfunction/activation and platelet reactivity by multiple electrode aggregometry were compared in 126 stable post-ACS subjects (mean age: 65 ± 10 years, 92 men and 34 women), including patients with (n = 61) or without (n = 65) coexistent type 2 diabetes (T2DM) on uneventful maintenance DAPT with either ticagrelor (90 mg b.d.) or clopidogrel (75 mg o.d.) in addition to low-dose aspirin. Our aim was to compare endothelial biomarkers and their relations with platelet reactivity in real-world patients after acute coronary syndrome (ACS) on maintenance dual antiplatelet therapy (DAPT) with ticagrelor or clopidogrel stratified by diabetes status. thienopyridine P2Y 12 blockers on endothelial function. There are conflicting data regarding effects of ticagrelor vs. Pleiotropic effects have been implicated in clinical benefits of ticagrelor compared to thienopyridine P2Y 12 antagonists.
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