What drives thrombogenesis despite antiplatelet therapy in diabetes mellitus?

Corresponding author: Robert F Storey, Department of Cardiovascular Science, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK. Email: r.f.storey@sheffield.ac.uk fibrillation will provide new information about the impact of thrombin inhibition on ischaemic events in diabetic compared with non-diabetic patients. Ongoing studies of the alternative strategy of targeting the principal platelet thrombin receptor, PAR-1, rather than thrombin itself will also reveal the potential of adding a further platelet inhibitor to aspirin and a P2Y 12 inhibitor in high-risk patients. This strategy has the advantage of more limited effects on haemostasis compared with anticoagulant therapies yet potentially synergistic antithrombotic effects and so the clinical trial results are eagerly awaited to determine whether it is possible to reduce rates of myocardial infarction and death without significantly compromising haemostasis. It is clear that the mechanisms by which diabetes mellitus drives increased propensity to thrombogenesis will continue to be unravelled in future work and our evolving scientific understanding will underpin new therapeutic strategies that reduce morbidity and mortality due to atherothrombosis in patients with diabetes mellitus.

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