Antithrombotic therapy in patients with diabetes mellitus. Diabetes mellitus and cardiovascular diseases

Cardiovascular disease (CVD) is the leading cause of death in patients with diabetes mellitus (DM) and despite modern therapeutic strategies, patients with DM have at least a two-fold increased risk of cardiovascular events. The prothrombotic state in patients with DM is associated with multiple determinants such as platelet alterations and endothelial dysfunction. Thus, proper antithrombotic strategies to reduce the risk of CVD in this population are critical. Recently, the COMPASS trial showed a net clinical benefit of the combination therapy of low-dose rivaroxaban plus acetylsalicylic acid, called dual antithrombotic therapy (DAT), when compared to acetylsalicylic acid in patients with chronic vascular disease (either peripheral artery disease [PAD] or chronic coronary syndrome [CCS]) and DM, even when it comes to all-cause mortality. Therefore, guidelines currently advise to evaluate DAT or dual antiplatelet therapy (DAPT) for high-risk patients with DM.