Original title: Impact of diabetes mellitus and metabolic syndrome on acute and chronic on-clopidogrel platelet reactivity in patients with stable coronary artery disease undergoing drug-eluting stent placement. Reference: Feldman L. et al. Am Heart J. 2014; Epub ahead of print.
Diabetes mellitus type 2 (T2DM) or metabolic syndrome patients undergoing drug eluting stent implantation have 3 to 4 more chances of presenting residual platelet reactivity after a clopidogrel loading dose than those that do not suffer any of these conditions.
Previous studies comparing chronic on clopidogrel platelet reactivity in patients with T2DM vs. non diabetic and in obese vs. non obese had showed contradicting outcomes.
This study included 159 patients receiving coronary angioplasty with DES and compared high platelet reactivity prevalence in T2DM or metabolic syndrome patients vs. patients with neither of these conditions. Platelet function was measured with a previous 600 mg clopidogrel loading dose and at 4 months on clopidogrel 75 mg treatment.
High reactivity prevalence was greater in diabetic patients and in patients with metabolic syndrome after clopidogrel loading dose, even though at 4 months this high reactivity was seen only in diabetic patients.
By multivariable analysis, diabetes (OR 3.62, IC 95%, 1.34 to 9.80; p=0.011), the metabolic syndrome (OR 4.00, IC 95% 1.39 to 11.46; p=0010) and the chronic previous treatment with clopidogrel (OR 0.22, IC 95% 0.09-0.49; p=0.001) were independent predictors of high on clopidogrel platelet reactivity.
Conclusion
Both the metabolic syndrome and T2DM were independent predictors of high on clopidogrel platelet reactivity after clopidogrel loading dose. This findings may be clinically relevant.
Editorial Comment
High platelet reactivity is associated to ischemic events, which is why several trials aim to reduce platelet reactivity by increasing clopidogrel loading dose or by choosing more powerful antiplatelets. Despite some of the outcomes may be favorable, the clinical efficacy of this changes remains unclear.
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