Antiplatelet and antithrombotic therapy in diabetic patients recent updates

Diabetes mellitus (DM) is a metabolic disorder associated with accelerated atherogenesis and an
increased risk of atherothrombotic complications. Multiple mechanisms contribute to the prothrombotic
status which characterizes DM patients underscoring the importance of antiplatelet
therapies used for secondary prevention in these patients. For many years, dual antiplatelet therapy
(DAPT) with aspirin and the P2Y12 inhibitor clopidogrel has represented the mainstay of treatment
following an acute coronary syndrome (ACS) or in patients undergoing percutaneous coronary
interventions (PCI). Although DAPT reduces the incidence of atherothrombotic recurrences, these rates
remain high in DM patients underscoring the need for more efficacious therapies. The present
manuscript provides an overview on the current status of knowledge on currently available antiplatelet
agents, focusing on the benefits and limitations of these therapies in DM patients, and evaluating the
potential role of new antithrombotic agents and treatment strategies currently under development to
overcome these limitations.