BACKGROUND: Diabetes is a known risk predictor for thromboembolic events in patients with atrial fibrillation (AF), but no study has explored the prognostic weight of insulin in this setting. OBJECTIVES: This study evaluated the differential role of insulin versus no insulin therapy on thromboembolic risk in patients with diabetes and AF. METHODS: We accessed individual patient data from the prospective, real-world, multicenter, PREFER in AF (European Prevention of thromboembolic events-European Registry in Atrial Fibrillation). We compared the rates of stroke/systemic embolism at 1 year according to diabetes status (no diabetes, diabetes without insulin therapy, diabetes on insulin therapy). RESULTS: In an overall population of 5,717 patients, 1,288 had diabetes, 22.4% of whom were on insulin. For patients with diabetes who were on insulin, there was a significantly increased risk of stroke/systemic embolism at 1 year versus either no diabetes (5.2% vs. 1.9%; hazard ratio: 2.89; 95% confidence interval: 1.67 to 5.02; p = 0.0002) or diabetes without insulin treatment (5.2% vs. 1.8%; hazard ratio: 2.96; 95% confidence interval: 1.49 to 5.87; p = 0.0019). Notably, rates of stroke/embolism were similar in patients with diabetes not receiving insulin versus patients without diabetes (hazard ratio: 0.97; 95% confidence interval: 0.58 to 1.61; p = 0.90). The selective predictive role of insulin-requiring diabetes was independent of potential confounders, including diabetes duration, and was maintained in various subpopulations, including the subgroup receiving anticoagulant therapy. CONCLUSIONS: In this cohort of anticoagulated patients with AF, the sole presence of diabetes not requiring insulin did not imply an increased thromboembolic risk. Conversely, insulin-requiring diabetes contributed most, if not exclusively, to the overall increase of thromboembolic risk in AF.

• MeSH
• diabetes mellitus 1. typu komplikace   MeSH
• fibrilace síní MeSH
• inzulin terapeutické užití   MeSH
• komplikace diabetu * MeSH
• lidé MeSH
• prospektivní studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• tromboembolie etiologie   prevence a kontrola   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Stent thrombosis (ST) is a rare but potentially life-threatening event that can occur following percutaneous coronary intervention (PCI) with stent implantation. Several factors related to the procedure or patient features can favor thrombus formation and development of ST. Dual Antiplatelet Therapy (DAPT) with aspirin and P2Y12 inhibitors is the cornerstone of strategy for reducing incidence of ST. Two main causes of DAPT failure have been identified: the inappropriately premature antiplatelet therapy discontinuation and hyporesponsiveness to antiplatelet drugs. There is growing evidence that a residual high on treatment platelet reactivity (HPR) is associated with increased risk of thrombotic complications after PCI, including ST. In recent years numerous platelet function tests were developed and some of these have been extensively used in clinical studies to evaluate residual platelet reactivity, after antiplatelet drugs administration. The identification of patients with HPR is fundamental for optimization of antiplatelet treatment. Nevertheless first studies suggested that achieving a more intense platelet inhibition, switching from standard to an intensified treatment regimen on the basis of platelet reactivity, has failed to show any benefit in terms of clinical events. Certainly individualized pharmacological treatment of patients undergoing PCI remains one of the most important objectives in order to prevent serious PCI complications, such us ST.

• MeSH
• agregace trombocytů účinky léků   MeSH
• inhibitory agregace trombocytů farmakologie   terapeutické užití   MeSH
• klinické zkoušky jako téma statistika a číselné údaje   MeSH
• koronární angioplastika MeSH
• koronární trombóza * etiologie   farmakoterapie   prevence a kontrola   MeSH
• lidé MeSH
• management farmakoterapie MeSH
• pooperační komplikace * farmakoterapie   prevence a kontrola   MeSH
• stenty * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH