Evidenced-Based Antithrombotic Therapy for Acute Coronary Syndromes

  1. Stefan James
  1. Department of Cardiology and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
  1. Corresponding author: Stefan James, stefan.james{at}

Patients with diabetes mellitus (DM) and acute coronary syndromes (ACSs) are at particularly high risk for recurrent cardiovascular events, including death. The reason for this increased risk is multifactorial, including underutilization of evidence-based medications in these patients (1). More research is needed to identify both the optimal antithrombotic strategy and duration of therapy, and greater attention is needed to implement therapies that have been shown to lower clinical events and mortality in this high-risk population. Together with lifestyle modification, improved attention to therapy can go a long way toward reducing ACS-related morbidity and mortality among people with diabetes.

Aspirin has been considered the mainstay of treatment for all patients with ACS, and its use is supported by strong and consistent evidence in current international guidelines (2,3). While a recent small study suggested that more frequent aspirin dosing would be beneficial in patients with DM (4), the CURRENT/OASIS7 (Clopidogrel Optimal Loading Dose Usage to Reduce Recurrent EveNTs/Optimal Antiplatelet Strategy for InterventionS) trial, a large study that included almost 6,000 patients with DM, was not able to show that a high dose of aspirin was superior to a low dose (5). Other recent trials have also shown that use of platelet function …

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