Korean Circ J.  2009 Nov;39(11):462-466. 10.4070/kcj.2009.39.11.462.

Comparison of Triple Anti-Platelet Therapy (Aspirin, Clopidogrel, and Cilostazol) and Double Anti-Platelet Therapy (Aspirin and Clopidogrel) on Platelet Aggregation in Type 2 Diabetic Patients Undergoing Drug-Eluting Stent Implantation

• Yang TH
• Kim DI
• Kim JY
• Kim IH
• Kim KH
• Han YC
• Kim W
• Seol SH
• Kim SM
• Kim DK
• Kim DS

• KMID: 2225648
• DOI: http://doi.org/10.4070/kcj.2009.39.11.462

Abstract

BACKGROUND AND OBJECTIVES
Triple anti-platelet therapy may produce more potent inhibition of platelet aggregation in patients undergoing coronary stent implantation. We tested whether this effect could be maintained in diabetic patients, where platelet reactivity is increased and the risk of stent thrombosis is higher.
SUBJECTS AND METHODS
Fifty five type 2 diabetic patients who had undergone drug-eluting stent (DES) implantation and chronic anti-platelet therapy (>1 month) were stratified according to the status of anti-platelet therapy. Platelet aggregation after adenosine diphosphate (ADP; 10 micronmol/L and 20 micronmol/L) stimulation was compared using light transmittance aggregometry between dual (aspirin plus clopidogrel, n=34) and triple therapy (aspirin, clopidogrel plus cilostazol, n=21) groups.
RESULTS
The 2 groups had similar clinical and procedural characteristics. Maximal ADP-induced platelet aggregation was significantly lower in the triple therapy group than the dual therapy group (ADP 10 micronmol/L, 37.1+/-15.4 vs. 28.3+/-11.8, p=0.03; ADP 20 micronmol/L, 63.1+/-15.0 vs. 49.1+/-15.1, p=0.01), but there were no differences in diabetic treatment (oral hypoglycemic agent vs. insulin) or diabetic control {hemoglobin Alc (HbA1c)< or =7 vs. HbA1c >7}.
CONCLUSION
Triple anti-platelet therapy showed more potent inhibition of maximal ADP induced platelet aggregation in type 2 diabetic patients receiving chronic anti-platelet therapy. This finding suggests that triple antiplatelet therapy may be more effective in preventing thrombotic complications after DES implantation in type 2 diabetic patients.

Keyword

Antiplatelet drugs; Diabetes mellitus; Platelet aggregation; Stents

MeSH Terms

Adenosine Diphosphate
Blood Platelets
Diabetes Mellitus
Drug-Eluting Stents
Humans
Light
Platelet Aggregation
Platelet Aggregation Inhibitors
Stents
Tetrazoles
Thrombosis
Ticlopidine
Adenosine Diphosphate
Platelet Aggregation Inhibitors
Tetrazoles
Ticlopidine

Figure

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  Fig. 1 Maximal platelet aggregation following ADP (10 and 20 µM) in type 2 diabetic patients according to anti-platelet drugs (Double, aspirin plus clopidogrel; Triple, aspirin, clopidogrel plus cilostazol). Numbers in the box denote the mean value of platelet aggregation. ADP: adenosine diphosphate.

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