Efficacy of antiplatelet therapy with ticagrelor or clopidogrel in patients with acute coronary syndrome and type 2 diabetes mellitus after angioplasty
Aim. To evaluate the efficacy and safety of dual antiplatelet therapy with ticagrelor/aspirin or clopidogrel/aspirin in patients with acute coronary syndrome (ACS) and type 2 dia- betes mellitus (DM).Material and methods. We enrolled in the study 336 ACS patients with and without DM, who were admitted to the intensive care unit. 172 patients underwent percutaneous coronary intervention (PCI). At admission patients were dis- tributed into two groups: clopidogrel loading dose of 600 mg followed by 75 mg once daily for 12 months (233 patients) and ticagrelor loading dose of 180 mg followed by 90 mg 2 twice daily for 12 months (103 patients). All patients received stan- dard ACS treatment, including aspirin. At 12 months we eval- uated the incidence of cardiovascular events (death + recurrent ischemia + acute heart failure) and bleedings. Results. The incidence of cardiovascular event in DM patients was higher than in patients without DM (in-hospital -12.1% and 57%, respectively; at one year - 31.2% and15.4% respectively). In DM group the dual antiplatelet treat-ment with clopidogrel and aspirin was associated with higherrisk of cardiovascular events than treatment with ticagrelorand aspirin (36.4% and 24.2%, respectively p<0,05), whileno difference was observed between clopidogrel and tica-grelor groups in patients with ACS but no DM (15.3% and15.7%, respectively). No significant difference in minorbleedings was seen between clopidogrel and ticagrelorgroups in patients with ACS and DM (9.0% and 15.1%) andACS but no DM (5.8% and 7.1%).Conclusion. The study showed no significant difference inefficacy between ticagrelor + aspirin and clopidogrel +aspirin in patients with ACS and normal glucose meatbolism,while in diabetic patients with ACS dual treatment with tica-grelor was associated with a significant decrease in adverseoutcomes. The incidence of minor bleedings was similarbetween clopidogrel and ticagrelor groups in patients withand without DM.