Diabetes mellitus (DM) is a metabolic disorder associated with accelerated
atherogenesis and an increased risk of atherothrombotic complications. Multiple mechanisms contribute to the pro-thrombotic status which characterizes DM patients underscoring the importance of antiplatelet
therapies used for
secondary prevention in these patients. For many years, dual antiplatelet
therapy (
DAPT) with
aspirin and the P2Y12 inhibitor
clopidogrel has represented the mainstay of treatment following an
acute coronary syndrome (ACS) or in patients undergoing
percutaneous coronary interventions (PCI). Although
DAPT reduces the incidence of atherothrombotic recurrences, these rates remain high in DM patients underscoring the need for more efficacious
therapies. Oral platelet P2Y12 receptor inhibitors with enhanced potency, such as
prasugrel and
ticagrelor, as well as antiplatelet
therapies such as
vorapaxar inhibiting the
thrombin-mediated platelet signaling pathway, constitute treatment opportunities for patients with DM and have shown to be associated with a greater reduction in ischemic recurrences, albeit at the cost of more
bleeding. This article reviews currently available
antiplatelet agents and delivers an update on the advances and drawbacks of these agents used for
secondary prevention in DM patients experiencing an ACS or undergoing PCI.