Loading
Diabetic Foot Disease / Diabetes Mellitus, Type 2 / Platelet Aggregation Inhibitors · Journal article
Annals of Medicine · April 14, 2026
Reinforces what was already believed, rather than introducing something new.
This observational study of 2,597 Taiwanese adults with type 2 diabetes, diabetic foot disease, and concurrent PAD found that aspirin monotherapy was associated with comparable amputation and cardiovascular outcomes but potentially lower all-cause mortality compared with clopidogrel or cilostazol after secondary prevention stabilization. Cilostazol showed significantly higher major adverse limb events (sHR 1.45) and both cilostazol and clopidogrel were associated with higher mortality than aspirin, though these observational findings require prospective verification.
Retrospective cohort study with inverse probability of treatment weighting adjustment. 2,597 adults with type 2 diabetes experiencing first diabetic foot disease event with concurrent peripheral arterial disease, identified from national health database in Taiwan, enrolled 2016–2019.. Intervention: Single antiplatelet monotherapy: aspirin, clopidogrel, or cilostazol for secondary prevention after diabetic foot disease event stabilization. Compared with: Aspirin (reference group for comparative analysis). n = 2,597. Taiwan (Taiwan Health and Welfare Data Center).
Cilostazol versus aspirin: higher risk of MALE (sHR 1.45 [95% CI 1.15–1.84]); clopidogrel showed nonsignificant trend (sHR 1.31 [95% CI 0.99–1.72]) All-cause mortality: cilostazol HR 1.21 [95% CI 1.06–1.39] and clopidogrel HR 1.25 [95% CI 1.07–1.46] versus aspirin Major lower extremity amputation (LEA) and major adverse cardiovascular events (MACE) did not differ significantly among treatment groups after adjustment
All-cause mortality: cilostazol HR 1.21 [95% CI 1.06–1.39] and clopidogrel HR 1.25 [95% CI 1.07–1.46] versus aspirin Major lower extremity amputation (LEA) and major adverse cardiovascular events (MACE) did not differ significantly among treatment groups after adjustment
For clinicians managing high-risk diabetic patients with PAD and prior foot disease, these observational findings suggest aspirin may be preferred over clopidogrel or cilostazol for secondary prevention given associations with lower mortality, though the evidence is not yet sufficient to change guideline recommendations without randomized trial confirmation.
Observational comparative effectiveness study with IPTW adjustment showing aspirin associated with lower mortality than alternatives in diabetic PAD patients with foot disease, but findings are from registry data without randomization and require prospective verification.
As stated by the source record.
Quoted from the source exactly as published.
For clinicians managing high-risk diabetic patients with PAD and prior foot disease, these observational findings suggest aspirin may be preferred over clopidogrel or cilostazol for secondary prevention given associations with lower mortality, though the evidence is not yet sufficient to change guideline recommendations without randomized trial confirmation.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background. Antiplatelet therapy is recommended for secondary prevention in patients with diabetes and peripheral arterial disease (PAD), particularly after a diabetic foot event. Nevertheless, the relative effectiveness of aspirin, clopidogrel, and cilostazol for long-term outcomes remains uncertain.Methods. Using the Taiwan Health and Welfare Data Center database, we identified 2,597 adults with type 2 diabetes who experienced their first diabetic foot disease (DFD) event with concurrent PAD between 2016 and 2019 and subsequently received a single antiplatelet agent for secondary prevention after stabilization. Outcomes included major lower extremity amputation (LEA), major adverse limb events (MALE), major adverse cardiovascular events (MACE), and all-cause mortality. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazards and Fine-Gray competing risk models were used to estimate hazard ratios (HRs) and subdistribution HRs (sHRs) with 95% confidence intervals (CIs).Results. Baseline characteristics indicated higher comorbidity burdens in the clopidogrel and cilostazol groups. After adjustment, the risks of LEA and MACE did not differ significantly among treatment groups. Compared with aspirin, cilostazol was associated with a higher risk of MALE (sHR 1.45 [95% CI 1.15-1.84]), whereas clopidogrel showed a nonsignificant trend (sHR 1.31 [95% CI 0.99-1.72]). Both cilostazol (HR 1.21 [95% CI 1.06-1.39]) and clopidogrel (HR 1.25 [95% CI 1.07-1.46]) were associated with higher all-cause mortality. Exploratory subgroup analyses showed no significant mortality differences among dialysis patients, and sensitivity analyses yielded consistent results.Conclusions. Among diabetic patients with PAD and a history of a foot event, aspirin was associated with comparable limb and cardiovascular outcomes, and potentially favorable survival, compared with clopidogrel or cilostazol. These observational findings suggest aspirin is a practical antiplatelet option for secondary prevention in this high-risk population, though further precise trials are needed to verify.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.