Patients with diabetes face a heightened risk of ischemic events after coronary stenting, yet the optimal antiplatelet strategy for secondary prevention remains debated. A post hoc analysis of the OPTION trial, published in the  Journal of Diabetes, evaluated the efficacy and safety of indobufen-based dual antiplatelet therapy (DAPT) compared with aspirin-based DAPT in patients with diabetes after coronary stenting with drug-eluting stents (DES). OPTION was a randomized, open-label, noninferiority, trial conducted across multiple centers in China, with patients randomized 1:1 to indobufen-based or aspirin-based DAPT.

Among 4551 patients, the 1-year primary composite endpoint—cardiovascular death, nonfatal myocardial infarction, ischemic stroke, definite or probable stent thrombosis, or BARC type 2, 3, or 5 bleeding—occurred in 93 of /1570 patients with diabetes (5.92%) and 148 of /2981 without diabetes (4.96%). Hazard ratios were similar for patients with diabetes (HR 0.72, 95% CI 0.47–1.08) and without diabetes (HR 0.73, 95% CI 0.53–1.01), with no significant interaction (Pinteraction = 0.935). 

Secondary efficacy and safety outcomes were also consistent between subgroups. Notably, safety outcomes showed favorable hazard ratios for indobufen in both diabetes (HR 0.56, 95% CI 0.34–0.92) and non-diabetes groups (HR 0.66, 95% CI 0.45–0.98).

The findings suggest that indobufen-based DAPT may represent a reasonable alternative to aspirin-based therapy for secondary prevention in patients with diabetes after DES implantation, particularly for those at high bleeding risk.