2023-05-09 12:12:00
[현대건강신문] A Korean research team identified the optimal antiplatelet therapy for diabetic patients who underwent coronary artery stent implantation. Among diabetic patients with stent implantation, the group taking clopidogrel as a single platelet inhibitor maintenance therapy was found to reduce the risk of cardiovascular events by regarding 30% compared to the aspirin group.
A research team led by Professors Hyo-Soo Kim and Kyung-Woo Park of Seoul National University Hospital (Professor Tae-Min Lee, Gangnam Center) published a study comparing the effects of clopidogrel and aspirin in the treatment of single antiplatelet agents in diabetic patients with stents inserted.
Coronary atherosclerosis is the cause of angina pectoris and myocardial infarction, and is a dangerous disease that causes sudden death. The standard treatment is to insert a stent. After stent insertion, two types of platelet inhibitors are taken simultaneously for the first few months to prevent stent thrombosis or restenosis, and even following stabilization, one type of platelet inhibitor must be taken throughout life.
Current international practice guidelines recommend aspirin as the single platelet inhibitor to be taken throughout life, but the scientific basis for this is lacking. In order to identify the optimal single platelet inhibitor, in 2021, Seoul National University Hospital Cardiology Department Professor Hyo-Soo Kim, Bon-Kwon Koo, Gyeong-Woo Park, and Ji-Hoon Kang published a multicenter randomized clinical study (HOST-EXAM), revealing the superiority of clopidogrel over aspirin for the first time in the world. .
However, it has not yet been studied whether clopidogrel is more effective than aspirin as a single platelet inhibitor following stent surgery in diabetic patients with a high risk of ischemia.
Accordingly, as a follow-up study of HOST-EXAM, the researchers conducted an analysis to identify the optimal single platelet inhibitor for diabetic patients.
In the preceding study, HOST-EXAM, patients who had no clinical events while taking dual platelet inhibitors for 6 to 18 months following drug-eluting stent implantation were randomly assigned to the clopidogrel group and the aspirin group in a 1:1 ratio. Each patient took a different single platelet inhibitor for 24 months.
These patients were followed up for 2 years with a composite cardiovascular event (death + myocardial infarction + stroke + acute recurrence of angina + severe bleeding) as the primary endpoint.
In the follow-up study conducted this time, the research team analyzed the HOST-EXAM follow-up results by dividing them into diabetic patients (1860 patients) and non-diabetic patients (3578 patients) according to the underlying disease of diabetes.
As a result of the analysis, clopidogrel as a single platelet inhibitor significantly reduced the risk of recurrence of cardiovascular events following stent implantation compared to aspirin, regardless of diabetes.
The risk of recurrent cardiovascular events in diabetic patients was 6.3% and 9.2% in the clopidogrel and aspirin groups, respectively. In other words, even in diabetic patients with a high risk of ischemia, when clopidogrel was used as a single platelet inhibitor maintenance therapy, the risk of cardiovascular event recurrence was reduced by 31% compared to aspirin.
The results were the same in non-diabetic patients. The risk of cardiovascular event recurrence in the non-diabetic clopidogrel group and the aspirin group was 5.3% and 7.0%, respectively, and the clopidogrel group showed a 24% reduction in the risk of cardiovascular event recurrence.
In other words, maintenance therapy with clopidogrel single platelet inhibitor, which is conducted to prevent the recurrence of cardiovascular events following stent insertion, is helpful in lowering the risk of recurrence regardless of diabetes, the research team explained.
“This study is meaningful as it proves the superiority of clopidogrel over aspirin as a single platelet agent for diabetic patients,” said Professor Park Kyung-Woo of the Department of Cardiology. It will be a safe and effective treatment for patients,” he said.
Meanwhile, the results of this study were published in the latest issue of ‘JAMA Cardiology (IF;30.2)’, an international journal in the field of cardiovascular disease.
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