• About
  • Masthead
  • License Content
  • Advertise
  • Submit Press Release
  • RSS/Email List
  • Write for us
  • Contact us
2 Minute Medicine
No Result
View All Result

No products in the cart.

SUBSCRIBE
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
2 Minute Medicine
  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • AccountLog-in/out
    • Subscribe
    • Sign-in
    • My account
SUBSCRIBE
2 Minute Medicine
Subscribe
Home All Specialties Cardiology

[JAMA] Clopidogrel lacks effectiveness in diabetics as compared to non-diabetics after myocardial infarction

bys25qthea
September 10, 2012
in Cardiology, Chronic Disease
Reading Time: 3 mins read
0
Share on FacebookShare on Twitter

Image: CC/Trounce

Primer: The 2011 AHA/ACCF guidelines for secondary prevention for patients with known coronary disease include a Class IB recommendation for 75mg clopidogrel as an alternative antiplatelet agent for patients who do not tolerate or are allergic to aspirin; in addition, dual antiplatelet therapy with aspirin and clopidogrel is recommended for patients after stent placement. Diabetic patients have increased platelet reactivity, and subgroup analyses of large trials including CHARISMA, CREDO, and CURE have shown have suggested clopidogrel is less effective in the diabetic population. This study used registry data to compare the efficacy of clopidogrel in diabetic and non-diabetic patients.

The [retrospective] study: Andersson, et al. used administrative data from Danish registries to follow patients who were hospitalized for incident myocardial infarction and survived their initial hospitalization. Patients were followed for one year after admission or until the end of 2009. Outcome measures included all-cause mortality, cardiovascular mortality, and a composite endpoint of repeat myocardial infarction and all-cause mortality.

The authors controlled for sex, age, income, year of admission, comorbidities, PCI in the month following MI, and other medications. The authors created separate binary dummy variables for clopidogrel treatment in diabetic and non-diabetic patients and analyzed both groups in a single model, and then also performed a propensity score analysis to confirm the results. A propensity score is the probability that a given patient received treatment based on observed characteristics based on regression; the propensity score can be used to match patients from the treated and untreated groups.

58,851 patients were included in the study, of whom 12% had diabetes and 60% received clopidogrel. Adjusted all-cause mortality for patients taking clopidogrel was 0.89 (CI 0.79-1.00) for patients with diabetes and 0.75 (95% CI, 0.70-0.80) for patients without diabetes and 0.93 (95% CI, 0.81-1.06) and 0.77 (95% CI, 0.72-0.83) for cardiovascular mortality. Notably, no difference in effect was noted for aspirin for patients in this cohort. Propensity score matching identified 2005 pairs of patients with diabetes and 11,410 pairs of patients, and the authors report a statistically significant effect of clopidogrel on the outcomes in non-diabetic patients (P < .0001 for all-cause and CV mortality and P < .01 for the combined end point) and no statistically significant differences for the patients with diabetes.

In sum:  This analysis further adds further evidence that clopidogrel does not provide a benefit to diabetic patients for secondary prevention, and serves as a reminder that diabetes has effects beyond vascular injury. As with all retrospective studies, this analysis cannot demonstrate causality, however, a significant strength of the study is the comprehensive nature of the registry data. The study generalizability is limited by the relatively homogenous population of Denmark.

The authors report the propensity score analysis confirms their multivariate regression. Notably, the authors did not attempt to match the diabetic and non-diabetic arms of the study in the propensity score analysis (see supplemental data) – they only matched patients within the diabetic and non-diabetic cohorts. Patients in the diabetic cohorts were more likely to have severe heart failure and less likely to undergo PCI, and there was a statistically significant (although the test is not specified) between the year of admission for the group receiving clopidogrel and those that did not. There is a built-in risk of rejecting an effect of clopidogrel in the diabetic cohort, particularly since fewer patients with diabetes were in the study population. Nevertheless, given previous study data and proposed mechanisms for the decreased effect of clopidogrel, the evidence from Denmark raises further questions about the appropriate anti-platelet therapy for diabetic patients, particularly after myocardial infarction and percutaneous intervention. The authors note TRITON-TIMI 38 suggested prasugrel was more effective than clopidogrel in patients with diabetes, and thus other thienopyridines may be more effective in this population.

RELATED REPORTS

Delta variant of SARS-CoV-2 infection associated with higher changes of severe maternal morbidities

Endoscopic sleeve gastroscopy effective for excess weight loss in type 1 and 2 obesity

#VisualAbstract: Early time-restricted eating was more effective for weight loss than eating over 12-hour window

Click to read in JAMA

© 2012 2minutemedicine.com. All rights reserved. No works may be reproduced without written consent from 2minutemedicine.com. DISCALIMER: Posts are not medical advice and are not intended as such. Please aee a healthcare professional if you seek medical advice. 

Previous Post

[The Lancet] Longer duration of resuscitation efforts associated with increased survival in patients with in-hospital cardiac arrests

Next Post

[BMJ] Elevated rheumatoid factor associated with 26x risk of developing rheumatoid arthritis

RelatedReports

Novel coronavirus identified from patients with pneumonia in Wuhan, China
Infectious Disease

Delta variant of SARS-CoV-2 infection associated with higher changes of severe maternal morbidities

August 17, 2022
Many new pediatric asthma cases attributable to obesity
Chronic Disease

Endoscopic sleeve gastroscopy effective for excess weight loss in type 1 and 2 obesity

August 17, 2022
#VisualAbstract: Early time-restricted eating was more effective for weight loss than eating over 12-hour window
StudyGraphics

#VisualAbstract: Early time-restricted eating was more effective for weight loss than eating over 12-hour window

August 17, 2022
Renal stones in women linked with increased risk of coronary heart disease
Emergency

Removal of asymptomatic kidney stones reduces risk of relapse

August 17, 2022
Next Post

[BMJ] Elevated rheumatoid factor associated with 26x risk of developing rheumatoid arthritis

[CANCER] Marijuana associated with increased risk of germ cell and nonseminoma testicular cancer

[Ann Emerg Med.] Topical antibiotics help prevent infection in minor wounds

License Our Award-Winning Physician-Written Medical News and Visual Abstracts

2 Minute Medicine is the leading authoritative medical news licensing service, and the only with reports written by practicing doctors.

LICENSE CONTENT

2MM+ Premium Access

No ads & unlimited access to all current reports, over 9000 searchable archived reports, visual abstracts, Weekly Rewinds, and the online edition of The Classics Series™ textbook.

Subscription Options
2 Minute Medicine

2 Minute Medicine® is an award winning, physician-run, expert medical media company. Our content is curated, written and edited by practicing health professionals who have clinical and scientific expertise in their field of reporting. Our editorial management team is comprised of highly-trained MD physicians. Join numerous brands, companies, and hospitals who trust our licensed content.

Recent Reports

  • Delta variant of SARS-CoV-2 infection associated with higher changes of severe maternal morbidities
  • Endoscopic sleeve gastroscopy effective for excess weight loss in type 1 and 2 obesity
  • #VisualAbstract: Early time-restricted eating was more effective for weight loss than eating over 12-hour window
License Content
Terms of Use | Disclaimer
Cookie Policy
Privacy Statement (EU)
Disclaimer

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.

  • Specialties
    • Cardiology
    • Chronic Disease
    • Dermatology
    • Emergency
    • Endocrinology
    • Gastroenterology
    • Imaging and Intervention
    • Infectious Disease
    • Nephrology
    • Neurology
    • Obstetrics
    • Oncology
    • Ophthalmology
    • Pediatrics
    • Preclinical
    • Psychiatry
    • Public Health
    • Pulmonology
    • Rheumatology
    • Surgery
  • Wellness
  • Classics™
    • 2MM+ Online Access
    • Paperback and Ebook
  • Rewinds
  • Visual
  • Partners
    • License Content
    • Submit Press Release
    • Advertise with Us
  • Account
    • Subscribe
    • Sign-in
    • My account

© 2021 2 Minute Medicine, Inc. - Physician-written medical news.