Initiating antiplatelet therapy in diabetes: a PCO view

Antiplatelet therapy has a role in the primary and secondary prevention of serious vascular events, especially in high-risk patients, including people with diabetes. This review considers the evidence and guideline recommendations for initiating antiplatelet therapy in people with diabetes with and without vascular disease. It concludes that, for diabetic patients with coronary heart disease, stroke or peripheral vascular disease, an antiplatelet agent (e.g. aspirin 75 mg per day or clopidogrel 75 mg per day) should be given routinely and continued in the long term. For diabetic patients with acute coronary syndromes, the addition of clopidogrel (75 mg daily) to usual therapy should be considered. For primary prevention, aspirin (75 mg) should be considered for all diabetic patients with well controlled hypertension and a ≥ 20% risk of developing coronary disease over 10 years.