Reticulated platelets and antiplatelet therapy response in diabetic patients

Increased platelet turnover and high level of reticulated platelets are associated with low response to antiplatelet therapy in diabetes mellitus type 2. This study evaluated association between percentage of reticulated platelets (%RP) and the response to antiplatelet therapy in patients with type 2 diabetes mellitus (T2DM). This prospective, pilot, case-control, clinical trial included 79 subjects stratified in three groups: group I included 30 patients with T2DM, group II included 34 non-diabetic patients and 15 healthy age and sex matched healthy volunteers were enrolled in control group. Platelet response to clopidogrel and aspirin was assessed by Multiplate(A (R)) aggregometry analyzer. Individual response to dual antiplatelet therapy was estimated by the percentage of decrease in overall platelet aggregability (%DPA) obtained after antiplatelet therapy, calculated by presented formulas: %DPA(adp) = 100 x (1 - ADP/TRAP) and %DPA(aspi) = 100 x (1 - ASPI/TRAP). %RP was significantly higher in diabetics, than in non-diabetics, (3.17 +/- A 1.26 vs. 2.39 +/- A 1.56; p < 0.05). Significantly lower response to clopidogrel (31.55 +/- A 13.02 vs. 50.24 +/- A 11.38; p < 0.001) and aspirin (52.33 +/- A 22.67 vs. 64.31 +/- A 16.47; p < 0.05) therapy was observed in diabetics. %RP negatively correlated with response to clopidogrel therapy, but positively with metabolic profile indicators in diabetics (p < 0.05, all). Correlation of %RP with metabolic profile indicators and poor response to antiplatelet therapy suggest that altered metabolic profile can affect platelet turnover in T2DM leading to low responsiveness to antiplatelet therapy in these patients.