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Droppa, M.; Spannagl, M. and Geisler, T. (2016): Diabetespatienten mit kardiovaskulärer Erkrankung. Fokus Thrombozytenaggregationshemmung. In: Diabetologe, Vol. 12, No. 1: pp. 49-65

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Abstract

Due to elevated platelet activation and procoagulatoric state, diabetic patients are at particular risk for ischemic cardiovascular events. Primary prophylactic antiplatelet treatment in patients without cardiovascular disease is not indicated. After cardiovascular interventions, especially after myocardial infarction, an intensified antiplatelet regime is warranted. In addition to aspirin, ticagrelor or prasugrel can be used, while a further possibility is triple antiplatelet treatment with aspirin, clopidogrel and vorapaxar or cilostazol after careful risk assessment. After myocardial infarction, prolonged therapy (more than 12 months) can be considered. An individual assessment of bleeding risk is necessary in particular in diabetics. In atrial fibrillation, the thromboembolic risk is elevated;thus, oral anticoagulation is of particular importance for stroke prevention. New direct anticoagulants have comparable effects in patients with diabetes compared to non-diabetics.

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