Type 2 diabetics with NSTE-ACS have antiplatelet-resistant thrombi
MedWire News: Patients with Type 2 diabetes have a greater thrombus burden after experiencing non-ST elevation acute coronary syndrome (NSTE-ACS) than nondiabetics, say UK researchers.
And their research suggests that thrombi in diabetics are more resistant to clot retraction on treatment with antiplatelet therapy than those in nondiabetics.
Girish Viswanathan from Newcastle University presented the results at the Diabetes UK Annual Professional Conference in London. The results were based on a study of 80 patients with coronary artery disease who experienced troponin-positive NSTE-ACS 1 week prior to being enrolled. The patients were aged 63 years on average and half had Type 2 diabetes.
The patients were all given 300 mg loading and 75 mg daily maintenance doses of aspirin and clopidogrel, respectively, to try to minimize their thrombus burden.
The researchers used a Badimon chamber, an ex vivo arterial injury model using blood taken from the participants combined with porcine aorta, to assess thrombus burden. In addition, 28 of the patients (14 with Type 2 diabetes) underwent thromboelastography to investigate clot kinetics.
Viswanathan reported that thrombus area was greater in patients with diabetes than controls, at 16,824 versus 14,413 µm2/mm. In addition, the viscoelastic tensile strength of the thrombi was lower in the diabetic compared with the nondiabetic patients, at a median clot index of 0.4 versus 1.6.
Thrombi from diabetic patients were also less susceptible to retraction after treatment with antiplatelet medication than thrombi from controls, at 27.7 versus 73.7 mm/min.
"Our findings may explain the higher risk of thrombotic events in patients with Type 2 diabetes on current antiplatelet therapy," said Viswanathan.
"These results support the need for individualized and more potent antithrombotic therapy in Type 2 diabetes mellitus," he suggested.
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By Helen Albert