Despite the growing number of studies on antithrombotic therapies for the treatment of vascular disease, randomized controlled trials (RCTs), particularly for secondary prevention, are scarce for patients with diabetes mellitus (DM), according to a review published June 14 in the European Heart Journal.

In the review, Ramzi A. Ajjan, MD, et al., explore the latest advances in antithrombotic therapies for the treatment of cerebrovascular disease, peripheral artery disease (PAD) and coronary artery disease (CAD) in patients with DM. The authors review therapies for primary prevention, active vascular occlusion and long-term secondary prevention, and examine the benefits and risks of antithrombotic therapy combinations for DM patients.

The authors emphasize the significant challenges in tailoring therapy based on the variable atherothrombotic risk in individuals, varying risk within an individual secondary to DM duration, and presence of complications and predisposition to bleeding events.

"The heterogeneous vascular risk in DM patients, which can vary in the same individual according to DM duration and development of complications, adds to the complexity and prevents guidelines from making concrete recommendations," write the authors. DM-specific studies are warranted in the future, however, "[this] will require greater collaboration between metabolic and vascular medical disciplines to design appropriate studies aiming to reduce vascular events and improve clinical outcomes in the high-risk DM population."

Clinical Topics: Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD)

Keywords: Fibrinolytic Agents, Coronary Artery Disease, Secondary Prevention, Peripheral Arterial Disease, Diabetes Mellitus, Cerebrovascular Disorders, Hemorrhage, Primary Prevention

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