The importance of intravenous antiplatelet therapy with abciximab during percutaneous coronary intervention in diabetic patients

Diabetic patients undergoing percutaneous coronary intervention have a much higher rate of ischemic complications than do nondiabetic patients. In part, this may be due to their increased propensity for platelet aggregation and thrombus formation. Potent antiplatelet blockade produced by inhibition of the glycoprotein IIb/IIIa receptor, the final common pathway in platelet aggregation, can decrease thrombus formation in response to balloon injury. A recent analysis demonstrated that, compared with placebo, the intravenous glycoprotein IIb/IIIa inhibitor abciximab, used at the time of the interventional procedure, decreased 1-year all-cause mortality in diabetic patients. Indeed, the mortality was reduced to a level comparable to that of placebo-treated nondiabetic patients. A striking mortality reduction was also noted in patients with diabetes who underwent multivessel intervention, a particularly controversial cohort to treat nonsurgically. Thus, platelet glycoprotein IIb/IIIa receptor blockade with abciximab is able to substantially improve the results of percutaneous intervention in patients with diabetes.