Antithrombotic therapy in diabetes: which, when, and for how long?
Antithrombotic therapy in diabetes: which, when, and for how long?
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DOI：
10.1093/eurheartj/ehab128
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发表时间：
2021-06-14
影响因子：
39.3
通讯作者：
Storey RF
中科院分区：
文献类型：
--
作者：
Ajjan RA;Kietsiriroje N;Badimon L;Vilahur G;Gorog DA;Angiolillo DJ;Russell DA;Rocca B;Storey RF
心血管疾病仍然是糖尿病（DM）患者死亡的主要原因，也导致了显著的发病率。过早和更具侵袭性的动脉粥样硬化疾病，加上血栓形成环境的增强，是糖尿病患者血管风险较高的原因。这种血栓形成环境是由于血小板活性增加以及凝血因子定量和定性变化引起的纤维蛋白溶解受损。然而，在糖尿病患者和非糖尿病患者中，降低血栓形成风险的管理策略在很大程度上是相似的。目前的综述涵盖了糖尿病抗血栓管理领域的最新研究。本文讨论了初级血管预防的作用，以及在不同的临床情况下，包括冠状动脉、脑血管和外周动脉疾病，发生缺血事件后的二级预防选择。联合抗血小板治疗以及联合抗血小板和抗凝剂在急性期和长期检查，包括管理个体与窦性心律和房颤。除了个体继发于糖尿病持续时间、并发症的存在和易出血事件外，根据不同个体不同的动脉粥样硬化血栓形成风险来定制治疗的困难也被强调。这篇综述为读者提供了糖尿病患者抗血栓管理的最新指南，并强调了代表未来研究领域的知识差距，旨在改善这一高危人群的临床结果。糖尿病中的动脉粥样硬化血栓形成。
Cardiovascular disease remains the main cause of mortality in individuals with diabetes mellitus (DM) and also results in significant morbidity. Premature and more aggressive atherosclerotic disease, coupled with an enhanced thrombotic environment, contributes to the high vascular risk in individuals with DM. This prothrombotic milieu is due to increased platelet activity together with impaired fibrinolysis secondary to quantitative and qualitative changes in coagulation factors. However, management strategies to reduce thrombosis risk remain largely similar in individuals with and without DM. The current review covers the latest in the field of antithrombotic management in DM. The role of primary vascular prevention is discussed together with options for secondary prevention following an ischaemic event in different clinical scenarios including coronary, cerebrovascular, and peripheral artery diseases. Antiplatelet therapy combinations as well as combination of antiplatelet and anticoagulant agents are examined in both the acute phase and long term, including management of individuals with sinus rhythm and those with atrial fibrillation. The difficulties in tailoring therapy according to the variable atherothrombotic risk in different individuals are emphasized, in addition to the varying risk within an individual secondary to DM duration, presence of complications and predisposition to bleeding events. This review provides the reader with an up-to-date guide for antithrombotic management of individuals with DM and highlights gaps in knowledge that represent areas for future research, aiming to improve clinical outcome in this high-risk population. Atherothrombosis in diabetes.
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影响因子：
20.3
作者：
Ajjan, Ramzi A.;Gamlen, Toby;Grant, Peter J.
通讯作者：
Grant, Peter J.
影响因子：
4.3
作者：
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影响因子：
6.2
作者：
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通讯作者：
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影响因子：
37.8
作者：
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通讯作者：
Faxon, David P.
影响因子：
24
作者：
Angiolill, Dominick J.;Baber, Usman;Mehran, Roxana
通讯作者：
Mehran, Roxana