DOI QR코드

DOI QR Code

당뇨병성 말초혈관병증에서 항혈소판제의 효과: 발목상완지수 및 맥파전달속도를 통한 비교

Effect of Antiplatelets in Diabetic Peripheral Vasculopathy: Comparison by Ankle-Brachial Index and Peak Wave Velocity

  • 박세진 (성균관대학교 의과대학 강북삼성병원 정형외과학교실)
  • Park, Se-Jin (Department of Orthopedic Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine)
  • 투고 : 2014.06.30
  • 심사 : 2014.10.04
  • 발행 : 2014.12.15

초록

Purpose: The purpose of this study is to confirm the effect of antiplatelet drugs in diabetic peripheral vasculopathy in diabetic foot patients. Materials and Methods: We designed a retrospective study in diabetic foot patients with diabetic peripheral vasculopathy. From October 2007 to December 2013, 278 cases in 139 patients who took antiplatelet drugs over at least a six-month period were included in this study. We categorized these patients according to the type of drug used. The efficacy of antiplatelet drugs was evaluated using anklebrachial index (ABI) and pulse wave velocity (PWV). Results: Only the aspirin group showed a statistically significant increase of ABI after antiplatelet therapy ($1.10{\pm}0.12$ to $1.12{\pm}0.11$). In addition, only the cilostazol group showed a statistically significant decrease of PWV after antiplatelet therapy ($1,701.20{\pm}396.56$ to $1,627.42{\pm}324.98$). Conclusion: Aspirin and cilostazol may be used in treatment of diabetic peripheral vasculopathy, whereas dual antiplatelet therapy with aspirin and clopidogrel has no specific benefits in diabetic peripheral vasculopathy.

키워드

참고문헌

  1. International Diabetes Federation. IDF diabetes atlas. 6th ed. Brussels: International Diabetes Federation; 2013.
  2. DiMinno G, Silver MJ, Cerbone AM, Murphy S. Trial of repeated low-dose aspirin in diabetic angiopathy. Blood. 1986;68:886-91.
  3. Colwell JA, Bingham SF, Abraira C, Anderson JW, Comstock JP, Kwaan HC, et al. Veterans Administration Cooperative Study on antiplatelet agents in diabetic patients after amputation for gangrene: II. Effects of aspirin and dipyridamole on atherosclerotic vascular disease rates. Diabetes Care. 1986;9:140-8. https://doi.org/10.2337/diacare.9.2.140
  4. Bridges JM, Dalby AM, Millar JH, Weaver JA. An effect of Dglucose on platelet stickiness. Lancet. 1965;1:75-7.
  5. Colwell JA, Nesto RW. The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care. 2003;26:2181-8. https://doi.org/10.2337/diacare.26.7.2181
  6. Angiolillo DJ. Antiplatelet therapy in diabetes: efficacy and limitations of current treatment strategies and future directions. Diabetes Care. 2009;32:531-40. https://doi.org/10.2337/dc08-2064
  7. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008;300:2134-41. https://doi.org/10.1001/jama.2008.623
  8. Belch J, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008;337:a1840. https://doi.org/10.1136/bmj.a1840
  9. Begelman SM, Jaff MR. Noninvasive diagnostic strategies for peripheral arterial disease. Cleve Clin J Med. 2006;73 Suppl 4:S22-9. https://doi.org/10.3949/ccjm.73.Suppl_4.S22
  10. Mackenzie IS, Wilkinson IB, Cockcroft JR. Assessment of arterial stiffness in clinical practice. QJM. 2002;95:67-74. https://doi.org/10.1093/qjmed/95.2.67
  11. Brooks B, Dean R, Patel S, Wu B, Molyneaux L, Yue DK. TBI or not TBI: that is the question. Is it better to measure toe pressure than ankle pressure in diabetic patients? Diabet Med. 2001;18:528-32. https://doi.org/10.1046/j.1464-5491.2001.00493.x
  12. Jeffcoate WJ, Harding KG. Diabetic foot ulcers. Lancet. 2003;361:1545-51. https://doi.org/10.1016/S0140-6736(03)13169-8
  13. Reiber GE, Boyko EJ, Smith DG. Lower extremity foot ulcers and amputations in diabetes. In: Harris MI, Cowie CC, Stern MP, Boyko EJ, Reiber GE, Bennett PH, editors. Diabetes in America. 2nd ed. Maryland: NIH publications; 1995. p.409-28.
  14. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293:217-28. https://doi.org/10.1001/jama.293.2.217
  15. Lipsky BA, Weigelt JA, Sun X, Johannes RS, Derby KG, Tabak YP. Developing and validating a risk score for lower-extremity amputation in patients hospitalized for a diabetic foot infection. Diabetes Care. 2011;34:1695-700. https://doi.org/10.2337/dc11-0331
  16. Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, et al. Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127:1425-43. https://doi.org/10.1161/CIR.0b013e31828b82aa
  17. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348:1329-39. https://doi.org/10.1016/S0140-6736(96)09457-3
  18. Bhatt DL, Marso SP, Hirsch AT, Ringleb PA, Hacke W, Topol EJ. Amplified benefit of clopidogrel versus aspirin in patients with diabetes mellitus. Am J Cardiol. 2002;90:625-8. https://doi.org/10.1016/S0002-9149(02)02567-5
  19. Ohashi S, Iwatani M, Hyakuna Y, Morioka Y. Thermographic evaluation of the hemodynamic effect of the antithrombotic drug cilostazol in peripheral arterial occlusion. Arzneimittelforschung. 1985;35:1203-8.
  20. Uchikawa T, Murakami T, Furukawa H. Effects of the anti-platelet agent cilostazol on peripheral vascular disease in patients with diabetes mellitus. Arzneimittelforschung. 1992;42:322-4.
  21. Katz MF, Farber HW, Dodds-Stitt Z, Cruikshank WW, Beer DJ. Serotonin-stimulated aortic endothelial cells secrete a novel T lymphocyte chemotactic and growth factor. J Leukoc Biol. 1994;55:567-73. https://doi.org/10.1002/jlb.55.5.567
  22. Yamakawa J, Takahashi T, Saegusa S, Moriya J, Itoh T, Kusaka K, et al. Effect of the serotonin blocker sarpogrelate on circulating interleukin-18 levels in patients with diabetes and arteriosclerosis obliterans. J Int Med Res. 2004;32:166-9. https://doi.org/10.1177/147323000403200209
  23. Norgren L, Jawien A, Mátyás L, Riegerd H, Arita K. Sarpogrelate, a 5-hT2A receptor antagonist in intermittent claudication. A phase II European study. Vasc Med. 2006;11:75-83. https://doi.org/10.1191/1358863x06vm657oa
  24. Ahn JC, Song WH, Kwon JA, Park CG, Seo HS, Oh DJ, et al. Effects of cilostazol on platelet activation in coronary stenting patients who already treated with aspirin and clopidogrel. Korean J Intern Med. 2004;19:230-6. https://doi.org/10.3904/kjim.2004.19.4.230
  25. Lee BK, Lee SW, Park SW, Lee SW, Park DW, Kim YH, et al. Effects of triple antiplatelet therapy (aspirin, clopidogrel, and cilostazol) on platelet aggregation and P-selectin expression in patients undergoing coronary artery stent implantation. Am J Cardiol. 2007;100:610-4. https://doi.org/10.1016/j.amjcard.2007.03.070
  26. Cassar K, Ford I, Greaves M, Bachoo P, Brittenden J. Randomized clinical trial of the antiplatelet effects of aspirin-clopidogrel combination versus aspirin alone after lower limb angioplasty. Br J Surg. 2005;92:159-65. https://doi.org/10.1002/bjs.4810
  27. Bhatt DL, Fox KA, Hacke W, Berger PB, Black HR, Boden WE, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006;354:1706-17. https://doi.org/10.1056/NEJMoa060989
  28. Berger JS, Bhatt DL, Steg PG, Steinhubl SR, Montalescot G, Shao M, et al. Bleeding, mortality, and antiplatelet therapy: results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. Am Heart J. 2011;162:98-105. https://doi.org/10.1016/j.ahj.2011.04.015