Skip to main content
SpringerLink
Log in

The Indication for Antithrombotic Primary Prophylaxis and Treatment in Case of Thromboembolic Complications in Patients with Metabolic Syndrome

  • Chapter
  • First Online:
The Metabolic Syndrome

  • 1938 Accesses

Abstract

In the literature guidelines for the use of antithrombotic drugs in patients with metabolic syndrome exclusively describes risk modifying treatment in the subpopulation of patients with diabetes mellitus (DM).

Patients with DM have a high risk for developing atherosclerosis and for thrombotic complications. In case of thrombotic complications the prognosis is worse in DM as compared to non-DM patients. In registries it have been shown that patients with DM do not receive an optimal reperfusion therapy as well as pharmacotherapy though the absolute risk reduction with an aggressive therapy is higher than in non-DM patients.

Aspirin therapy should be used in primary prophylaxis in DM patients with high risk features .

Clopidogrel instead of aspirin should be considered in secondary prophylaxis of DM patients with previous ACS, ischaemic stroke or PAD especially in case of polyvascular disease. Dual platelet inhibition cannot be recommended in stable patients except in a limited period in case of treatment with coronary stents.

In ACS DM patients should be offered reperfusion with either PCI or CABG if indicated and antiplatelet therapy with one of the new P2Y12 receptor antagonists ticagrelor or prasugrel instead of clopidogrel together with aspirin for 12 months. The choise of monotherapy with an antiplatelet drug beyond 12 months is on an individual basis.

Independent on that new treatment options are available the risk of ischaemic events and mortality in atherosclerotic DM patients are still very high. Continued scientific activity and clinical trials to optimize the therapy are highly recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Laakso MLS (1997) Epidemiology of macrovascular disease in diabetes. Diabetes Rev 5:294–315

    Google Scholar 

  2. Haffner SM, Letho S, Ronnema T et al (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med 39:229–234

    Article  Google Scholar 

  3. Baigent C, Blackwell L, Collins R et al (2009) Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials. Lancet 373:1849–1860

    Article  PubMed  Google Scholar 

  4. Brieger D, Fox KA, Fitzgerald G et al (2009) Predicting freedom from clinical events in non-ST-elevation acute coronary syndromes. The Global Registry of Acute Coronary Events. Heart 95:888–894

    Article  PubMed  CAS  Google Scholar 

  5. Anderson HV, Shaw RE, Brindis RG et al (2002) A contemporary overview of percutaneous coronary interventions. The American College of Cardiology – National Cardiovascular Data Registry (ACC-NCDR). J Am Coll Cardiol 39:1096–1103

    Article  PubMed  Google Scholar 

  6. Donahoe SM, Stewart GC, McCabe CH et al (2007) Diabetes and mortality following acute coronary syndromes. JAMA 298:765–775

    Article  PubMed  CAS  Google Scholar 

  7. Machecourt J, Danchin N, Lablanche JM et al (2007) Risk factors for stent thrombosis after implantation of sirolimus-eluting stents in diabetic and nondiabetic patients: the EVASTENT Mached-Cohort Registry. J Am Coll Cardiol 50:501–508

    Article  PubMed  CAS  Google Scholar 

  8. Nesto RW (2004) Correlation between cardiovascular disease and diabetes mellitus: current concepts. Am J Med 116(Suppl 5A):11S–22S

    Article  PubMed  Google Scholar 

  9. Colwell JA, Nesto RW (2003) The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care 26:2181–2188

    Article  PubMed  Google Scholar 

  10. Ferroni P, Basili S, Falco A, Davi G (2004) Platelet activation in type 2 diabetes mellitus. J Thromb Haemost 2:1282–1291

    Article  PubMed  CAS  Google Scholar 

  11. El Haouari M, Rosado JA (2008) Platelet signalling abnormalities in patients with type 2 diabetes mellitus: a review. Blood Cells Mol Dis 41:119–123

    Article  PubMed  CAS  Google Scholar 

  12. Meigs JB, Mittleman MA, Nathan DM et al (2000) Hyperinsulinemia, hyperglycemia, and impaired hemostasis: the Framingham Offspring Study. JAMA 282:221–228

    Article  Google Scholar 

  13. Juhan-Vague I, Alessi MC, Vague P (1996) Thrombogenic and fibrinolytic factors and cardiovascular risk in non-insulin-dependent diabetes mellitus. Ann Med 28:371–380

    Article  PubMed  CAS  Google Scholar 

  14. Schneider DJ, Nordt TK, Sobel BE (1993) Attenuated fibrinolysis and accelerated atherogenesis in type II diabetic patients. Diabetes 42:1–7

    Article  PubMed  CAS  Google Scholar 

  15. Nordt TK, Bode C (2000) Impaired endogenous fibrinolysis in diabetes mellitus: mechanisms and therapeutic approaches. Semin Thromb Hemost 26:495–501

    Article  PubMed  CAS  Google Scholar 

  16. Natarajan A, Zaman AG, Marshall SM (2008) Platelet hyperactivity in type 2 diabetes: role of antiplatelet agents. Diab Vasc Dis Res 5:138–144

    Article  PubMed  Google Scholar 

  17. Belch J, MacCuish A, Campbell I et al (2008) The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomized placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. Br Med J 337:a1840

    Article  Google Scholar 

  18. Seshasai SR, Wijesuriya S, Sivakumaran R et al (2012) Effect of aspirin on vascular and nonvascular outcomes: meta-analysis of randomized controlled trials. Arch Intern Med 172:209–216

    Article  PubMed  CAS  Google Scholar 

  19. American Diabetes Association (2011) Executive Summary: Standards of Medical Care in Diabetes—2011. Diabetes Care 34(Suppl 1):S4–S10

    Google Scholar 

  20. Pignone M, Alberts MJ, Colwell JA et al (2010) Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation 121:2694–2701

    Article  PubMed  Google Scholar 

  21. Doteval A, Hasdai D, Wallentin L, Battler A, Rosengren A (2005) Diabetes mellitus: clinical presentation and outcome in men and women with acute coronary syndromes. Data from the Euro Heart Survey ACS. Diabet Med 22:1542–1550

    Article  Google Scholar 

  22. Donahoe SM, Stewart GC, McGabe CH et al (2007) Diabetes and mortality following acute coronary syndromes. JAMA 298:765–775

    Article  PubMed  CAS  Google Scholar 

  23. Hasin T, Hochadel M, Gitt AK et al (2009) Comparison of treatment and outcome of acute coronary syndrome in patients with versus patients without diabetes mellitus. Am J Cardiol 103:772–778

    Article  PubMed  Google Scholar 

  24. Hamm CW, Bassand J-P, Agewall S et al (2011) ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J 32:2999–3054

    Article  PubMed  Google Scholar 

  25. Steg PG, James SK, Atar D et al (2012) ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 33:2569–2619

    Article  PubMed  CAS  Google Scholar 

  26. Cannon CP, Weintraub WS, Demopoulos LA et al (2001) Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 344:1879–1887

    Article  PubMed  CAS  Google Scholar 

  27. Hatky MA, Boothroyd DB, Bravata DM et al (2009) Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 373:1190–1197

    Article  Google Scholar 

  28. Wiviott S, Braunwald E, McGabe C et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 357:2001–2015

    Article  PubMed  CAS  Google Scholar 

  29. Wallentin L, Becker RC, Budaj A et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 361:1045–1057

    Article  PubMed  CAS  Google Scholar 

  30. Wiviott SD, Braunwald E, Angiolillo DJ et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel. Thrombolysis in Myocardial Infarction 38. Circulation 118:1626–1636

    Article  PubMed  CAS  Google Scholar 

  31. James S, Angiolillo DJ, Cornel JH et al (2010) Ticagrelor vs clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J 31:3006–3016

    Article  PubMed  CAS  Google Scholar 

  32. DiChiara J, Bliden KP, Tantry US et al (2007) The effect of aspirin dosing on platelet function in diabetic and nondiabetic patients: an analysis from Aspirin-Induced Platelet Effect (ASPECT) study. Diabetes 56:3014–3019

    Article  PubMed  CAS  Google Scholar 

  33. Rocca B, Santilli F, Pitocco D et al (2012) The recovery of platelet cyclooxygenase activity explains interindividual variability in reponsiveness to low-dose aspirin in patients with and without diabetes. J Thromb Haemost 10:1220–1230

    Article  PubMed  CAS  Google Scholar 

  34. CAPRIE Steering Committee (1996) A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339

    Article  Google Scholar 

  35. Bhatt D, Marso S, Hirsch A et al (2002) Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol 90:625–628

    Article  PubMed  Google Scholar 

  36. American Diabetes Association, Colwell JA (2004) Aspirin therapy in diabetes. Diabetes Care 27(Suppl 1):S72–S73

    PubMed  Google Scholar 

  37. Bhatt DL, Fox KA, Hacke W et al (2006) Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med 354:1706–1717

    Article  PubMed  CAS  Google Scholar 

  38. Diener HC, Bogousslavsky J, Brass LM et al (2004) Aspirin and copidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet 364:331–337

    Article  PubMed  CAS  Google Scholar 

  39. Sacco RL, Diener HC, Yusuf S et al (2008) Aspirin and extended release dipyridamole versus clopidogrel for recurrent stroke. N Engl J Med 359:1238–1251

    Article  PubMed  CAS  Google Scholar 

  40. Camm AJ, Lip GY, DeCaterina R et al (2012) Focused update of the ESC guidelines for the management of atrial fibrillation. An update of the 2010 ESC guideline for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 33:2719–2747

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Region Hospital West, Aarhus, Denmark

    Steen Husted

Authors
  1. Steen Husted
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steen Husted .

Editor information

Editors and Affiliations

  1. Dept. Endocrinology, Odense University Hospital, Kloevervaenget 6 4, Odense C, 5000, Denmark

    Henning Beck-Nielsen

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Wien

About this chapter

Cite this chapter

Husted, S. (2013). The Indication for Antithrombotic Primary Prophylaxis and Treatment in Case of Thromboembolic Complications in Patients with Metabolic Syndrome. In: Beck-Nielsen, H. (eds) The Metabolic Syndrome. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1331-8_11

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-1331-8_11

  • Published:

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-1330-1

  • Online ISBN: 978-3-7091-1331-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation