Evidence mapPaperPMID 41981998Full record

ArticleAnnals of medicine2026

Prognostic implications of single antiplatelet therapy in individuals developing diabetic foot disease with concurrent peripheral arterial disease.

Cheng-Wei Lin, Yu-Yao Huang, Chia-Hung Lin, Chung-Huei Huang, Shih-Yuan Hung, I-Wen Chen, Yi-Chia Chen, Pi-Hua Liu

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Article in Annals of medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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8 authors.

Cheng-Wei LinDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0001-8922-7030
Yu-Yao HuangDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0002-4501-6140
Chia-Hung LinDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0002-4684-444X
Chung-Huei HuangDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0001-6736-1423
Shih-Yuan HungDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0002-9243-6586
I-Wen ChenDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0002-8928-6417
Yi-Chia ChenDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.
Pi-Hua LiuDepartment of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan.ORCID 0000-0002-7165-6248

Funding

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6 · The paper itself

Abstract

backgroundAntiplatelet 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.

methodsUsing 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).

resultsBaseline 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.

conclusionsAmong 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.

Indexed as

Diabetes Mellitus, Type 2Diabetic FootPeripheral Arterial DiseasePlatelet Aggregation InhibitorsAgedAmputation, SurgicalAspirinCilostazolClopidogrelFemaleHumansMaleMiddle AgedPrognosisSecondary PreventionTaiwanAspirinCilostazolClopidogrelPlatelet Aggregation Inhibitorsantiplatelet therapyDiabetic foot diseaselower-extremity amputationmajor adverse cardiovascular eventmajor adverse limb eventperipheral arterial diseasesurvival

Identifiers

PMID41981998
PMCPMC13084838

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.