Effect of exogenous insulin on platelet reactivity in patients with
acute ischemic vascular events
Objective: Recent studies have shown that insulin therapy increased the
risk of major cardiovascular adverse events, and the changes of platelet
reactivity may be responsible for the clinical outcomes. We attempted to
explore the effect of exogenous insulin on platelet function in patients
with type 2 diabetes mellitus who were suffering from acute vascular
events. Methods: We collected data of 540 diabetes patients with acute
ischemic vascular events from the hospital information system. Their
platelet reactivity has been reported by the maximum amplitude of
adenosine diphosphate-induced platelet-fibrin clots (MAADP) of
thromboelastography. The effect of antidiabetic drugs on platelet
reactivity was analyzed retrospectively. Stratified regression analysis
was carried out to gradually adjust for the demographic data, genetic
factors, lifestyle, biochemical indicators, antiplatelet regimen, etc.
Results: Univariate linear regression analysis showed that sex, age,
body mass index, smoking, low-density lipoprotein, platelet count,
CYP2C19*2, antiplatelet regimens, and insulin were related to MAADP.
After multiple factors were adjusted, the effect of insulin therapy
(95% CI: 0.022-0.664; p =0.036) on MAADP was always statistically
significant. Conclusions: Exogenous insulin effects significantly on the
level of MAADP in diabetic patients with acute ischemic vascular events,
which may be not conducive to antiplatelet therapy.