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Journal of Cardiovascular Nursing:
doi: 10.1097/JCN.0b013e31828530aa
DEPARTMENTS: Cochrane Nursing Care Corner

Summaries of Nursing Care–Related Systematic Reviews From the Cochrane Library: Adenosine-Diphosphate Receptor Antagonists for the Prevention of Cardiovascular Disease in Type 2 Diabetes Mellitus

Zheng, Sun BN; Min, Zhang BN; Yanqing, Hao BN

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Author Information

Sun Zheng, BN Associate Professor in School of Population and Family Planning, Taishan Medical University, Taian City, Shandong Province, People’s Republic of China.

Zhang Min, BN Masters in Nursing Student, Research Student, School of Population and Family Planning, Taishan Medical University, Taian City, Shandong Province, People’s Republic of China.

Hao Yanqing, BN Masters in Nursing Student, Research Student, School of Population and Family Planning, Taishan Medical University, Taian City, Shandong Province, People’s Republic of China.

Members of the Cochrane Nursing Care Field.

The authors have no conflicts of interest to disclose.

Correspondence Hao Yanqing, BN, No. 2 Yingsheng East Road, School of Population and Family Planning, Taishan Medical University, Taian City, Shandong Province 271000, People’s Republic of China (haoyanqing1011@126.com).

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Relevance to Nursing

Cardiovascular disease (CVD) is the most prevalent complication of type 2 diabetes, and about 65% of type 2 diabetes patients die of a cause related to atherosclerosis. Adenosine-diphosphate (ADP) receptor antagonists can prevent the aggregation (“clumping”) of platelets and consequently reduce the formation of blood clots. In the general population, these medications are used to prevent CVD such as myocardial infarctions and strokes. The aim of this review was to assess whether these ADP receptor antagonists would be effective in the prevention of CVD in type 2 diabetes.

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Study Characteristics

The review1 included 8 studies (3 investigated ticlopidine compared with aspirin or placebo and 5 investigated clopidogrel compared with aspirin or a combination of aspirin and dipyridamole or compared clopidogrel in combination with aspirin with aspirin alone) with a total of 21 379 patients. All participants in the included studies were patients with type 2 diabetes, and all patients were with previous CVD, except those in the CHARISMA trial, whose participants had previous cardiovascular or cerebrovascular events. Duration of follow-up had to be at least 12 months; however, the average was 913 days. The authors stated that the methodological quality of the 8 included trials was high. All of the trials except 1 were double blind. The review focused on outcomes such as mortality, cardiovascular events, and adverse effects. Meta-analysis was undertaken where possible.

In a pooled analysis of the study (355 patients), when compared with placebo, ticlopidine was noted to have no significant difference in the effect on all-cause mortality (odds ratio [OR], 1.29; 95% confidence interval [CI], 0.71–2.32) or vascular mortality (OR, 0.94; 95% CI, 0.47–1.88) or on reducing fatal and nonfatal myocardial infarction (OR, 0.78; 95% CI, 0.9–1.57).

In a meta-analysis of 2 trials (30% of the total diabetes participants), there was no significant reduction in the combination of fatal and nonfatal stroke for ADP receptor antagonists versus other antiplatelet drugs (OR, 0.81; 95% CI, 0.44–1.49).

In 1 of the above studies, there was a reduction in fatal and nonfatal stroke with the use of ticlopidine versus aspirin (OR, 0.56; 95% CI, 0.33–0.94). When compared with aspirin combined with dipyridamole, clopidogrel was noted to have no statistically significant reduction in fatal and nonfatal strokes in diabetes patients (OR, 1.12; 95% CI, 0.05–1.32).

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Best Practice Recommendations

The effect of ADP receptor antagonists in patients with diabetes is unclear. Outcomes for patients with diabetes should be reported separately in future trials. More evidence resulting from analysis done on all patients, including those with and without diabetes, is needed to guide the use of ADP receptors to prevent CVD.

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REFERENCE

1. Valentine N, Van de Laar FA, van Driel ML. Adenosine-diphosphate (ADP) receptor antagonists for the prevention of cardiovascular disease in type 2 diabetes mellitus. Cochrane Database Syst Rev. 2012; (11): 1–43: Art. no. CD005449. DOI 10.1002/14651858. CD005449.pub2.

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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