WOEST First randomised trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting. Dewilde.

Slides:



Advertisements
Présentations similaires
unstable angina undergoing PCI.
Advertisements

PRAGUE-8 PRAGUE-8 ESC 2007.
ATOLL Acute STEMI treated with primary PCI and intravenous enoxaparin or UFH to lower ischemic and bleeding events at short and long-term follow-up. Montalescot.
ATLAS ACS 2 -TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome.  Présentée.
TITRATION DU CLOPIDOGREL Tailored Clopidogrel Loading Dose according to Platelet Reactivity Monitoring Decrease Early Stent Thrombosis. Paganelli F et.
SYNTAX The synergy between percutaneous coronary intervention with TAXUS and cardiac surgery. Primary endpoint results at one year in the randomized cohort.
CARESS-AMI Combined Abciximab Reteplase Stent Study in Acute Myocardial Infarction ESC CARESS-AMI.
TRITON-TIMI 38 Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes.
ISAR-REACT Anti-GPIIbIIIa (abciximab) en complément d’une dose de charge en clopidogrel avant angioplastie avec mise en place d’une endoprothèse coronaire.
EXPLORE-Xa Betrixaban Compared With Open‑Label Dose-Adjusted Warfarin in Patients With Non-Valvular Atrial Fibrillation. Ezekowitz MD et al. ACC 2010.
Actualités sur les antiagrégants plaquettaires
TRA-CER Vorapaxar, a platelet thrombin receptor antagonist, in acute coronary syndromes. Mahaffey KW et al . AHA 2011.
ISAR REACT 3A A trial of reduced dose of unfractioned heparin in biomarker negative patients undergoing percutaneous coronary intervention. Schulz S et.
Platelet inhibition with cangrelor in patients undergoing PCI.
PRODIGY Prolonging dual antiplatelet treatment after grading stent-induced intimal hyperplasia study Valgimigli M et al. ESC 2011.
TRITON-TIMI 38 Evaluation of Prasugrel Compared with Clopidogrel in Patients with Acute Coronary Syndromes and Planned Percutaneous Coronary Intervention:
EARLY-ACS Inhibition de la glycoprotéine IIb/IIIa dans le syndrome coronarien aigu sans sus-décalage de ST Newby K et al. ACC Anti-GPIIb/IIIa précoce.
Tests d’évaluation de la réactivité plaquettaire
TRITON-TIMI 38 Trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infraction.
Revascularisation coronaire : ATL-endoprothèses ou chirurgie ?
AIDA STEMI The abciximab intracoronary versus intravenously drug application in ST-elevation myocardial infarction (AIDA STEMI). Thiele H et al. AHA 2011.
Efficacy and safety of rivaroxaban compared with warfarin among elderly patients with nonvalvular atrial fibrillation in the Rivaroxaban once daily, oral,
CHARISMA Analyse post-hoc Complications hémorragiques de l’association clopidogrel + aspirine chez les patients avec maladie vasculaire stable ou avec.
PRAGUE-14 Perioperative cardiovascular complications versus perioperative bleeding in patients with cardiovascular complications undergoing non- cardiac.
FREEDOM Strategies for Multivessel Revascularization in Patients with Diabetes N Engl J Med 2012 DOI : /NEJMoa Farkouh ME et al. AHA 2012.
Reduction of stent thrombosis in patients with acute coronary syndromes treated with rivaroxaban in ATLAS-ACS TIMI 51 ATLAS ACS 2 –TIMI 51 * Gibson CM.
FAME 2 Fractional Flow Reserve-Guided PCI versus Medical Therapy in Stable Coronary Disease De Bruyne B et al. ESC 2012.
CHARISMA Clopidogrel + aspirine contre aspirine seule pour la prévention des accidents athérothrombotiques. Bhatt DL et al. N Engl J Med 2006;354:
Aspirin in Patients Undergoing Non Cardiac Surgery POISE 2 Devereaux PJ et al. NEJM 2014;370:
POISE-2 Aspirin in patients undergoing noncardiac surgery ACC Devereaux P.J, et al. N Engl J Med 2014 ; 370 :
MTEV ET CANCER EVOLUTIF Thrombose veineuse chez les patients atteints de cancer évolutif Seddighzadeh A et al. Thromb Haemost 2007; 98: Venous.
ACTIVE A Prévention des événements de la fibrillation auriculaire par le clopidogrel Effect of Clopidogrel added to Aspirin in patients with Atrial Fibrillation.
JPPP Low-dose aspirin for primary prevention of cardiovascular events in elderly patients with multiple atherosclerotic risk factors. A randomized control.
Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention : systematic review and meta-analysis. Enoxaparine.
Explore the efficacy and safety of once-daily oral rivaroxaban for the prevention of cardiovascular events in subjects with non-valvular atrial fibrillation.
Prasugrel vs Clopidogrel for Acute Coronary Syndromes without Revascularization TRILOGY ACS Roe MT et al. N Engl J Med 2012 ; 367:
Edoxaban versus warfarin in patients with atrial fibrillation. ENGAGE-AF TIMI 48 Giugliano RP, et al. N Engl J Med 2013 ; 369 :
ASPIRE Low-dose Aspirin for Preventing Recurrent Venous Thromboembolism N Engl J Med 2012 DOI : /NEJMoa Brighton TA et al. AHA 2012.
RE-MODEL Study Essai clinique randomisé comparant
X-VERT Explore the efficacy and safety of once-daily oral rivaroxaban for the prevention of cardiovascular events in subjects with non-valvular atrial.
Antiagrégants et Cardiologie Interventionnelle
Dabigatran versus Warfarin in Patients with Mechanical Heart Valves
Moderate Pulmonary Embolism treated with thrombolysis
Dabigatran versus Warfarin in Patients with Mechanical Heart Valves
ADVANCE-3 Apixaban versus enoxaparin for thromboprophylaxis after hip replacement Lassen MR et al NEJM 2010; 363 :
CHAMPION PHOENIX Effect of Platelet Inhibition with Cangrelor during PCI on Ischemic Events Bhatt D.L, et al. N Engl J Med 2013 Bhatt DL et al. ACC 2013.
Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm
PROTECT Stent thrombosis and major clinical events at 3 years after zotarolimus-eluting or sirolimus-eluting coronary stent implantation : a randomised.
ATLAS ACS 2 – TIMI 51 Anti-Xa therapy to lower cardiovascular events in addition to standard therapy in subjects with acute coronary syndrome Gibson CM.
1–Thrombolysis in myocardial infarction
ATLANTIC Administration of Ticagrelor in the cath lab or in the ambulance for new ST elevation myocardial infarction to open the coronary artery Montalescot.
IST-3 The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6h of acute ischaemic stroke (the third international.
CALISTO Fondaparinux pour le traitement
ATLAS ACS-TIMI 46 Rivaroxaban versus placebo dans le SCA
Surveillance AVK Warfarin dose assessment every 4 weeks versus every 12 weeks in patients with stable international normalized ratios.
WOEST First randomised trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting. Dewilde.
Pr L CHRISTIAENS Actualités ESC 2017 Pr L CHRISTIAENS
ACCOAST Pretreatment with prasugrel in non-ST elevation acute coronary syndromes ESC 2013 Montalescot G, et al. N Engl J Med 2013.
Dabigatran versus warfarin in patients with atrial fibrillation.
AMADEUS Comparaison de l’idraparinux avec les AVK en prévention des accidents thrombo-emboliques de la fibrillation auriculaire : étude randomisée, ouverte,
HOKUSAI-VTE Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism ESC 2013 Büller HR et al. N Engl J Med 2013 ; 369 :
Platelet inhibition and patient outcomes
Strategies for Multivessel Revascularization in Patients with Diabetes
Traitement en double-aveugle Puissance pour supériorité
TRA 2° P Vorapaxar in the secondary prevention in atherothrombotic events Morrow DA et al. N Engl J Med 2012 ; 366 : Morrow DA et al. ACC 2012.
Étude ASCEND : AAS 100 mg/jour chez diabétiques sans maladie cardio-vasculaire à l’inclusion (1) Réalisée au Royaume-Uni 63 ans d’âge moyen, 63.
Étude VERDICT : approche invasive précoce dans les NSTEMI (1)
Host-ASSURE Adjunctive Cilostazol vs double dose clopidogrel after PCI with drug eluting stent Hyo-Soo K et al. ACC 2012.
TRILOGY ACS Prasugrel vs Clopidogrel for Acute Coronary Syndromes Patients managed without Revascularization. Ohman M, et al. ESC 2012.
PROTECT Stent thrombosis and major clinical events at 3 years after zotarolimus-eluting or sirolimus-eluting coronary stent implantation : a randomised.
Transcription de la présentation:

WOEST First randomised trial comparing two regimens with and without aspirin in patients on oral anticoagulant therapy undergoing coronary stenting. Dewilde W, et al. ESC 2012

WOEST Méthodologie Objectif Etude Critères d’inclusion Evaluer l’efficacité du clopidogrel seul contre l’association aspirine- clopidogrel en cas de traitement anticoagulant au long cours (AVK pour FA ou valve mécanique) et indication d’un ATL-stent coronaire. Etude Étude prospective, randomisée, multicentrique, binationale (Belgique, Pays-Bas) Critères d’inclusion Patients sous AVK éligibles pour une ATL coronaire WOEST Dewilde W, et al. ESC 2012

WOEST Schéma de l’étude R Clopidogrel 75mg/jour (n = 279) Critère de jugement principal Hémorragies tous types (TIMI) ATL coronaire / AVK n = 563 WOEST R Clopidogrel 75mg/jour + Aspirine 80mg/jour (n = 284) Suivi : 12 mois Durée AAP : ≥ 1 mois si stent inactif 12 mois si stent actif Dewilde W, et al. ESC 2012

Résultats Critère principal WOEST Dewilde W, et al. ESC 2012

WOEST Résultats Critère secondaire Décès IDM Reprise ATL AVC Bithérapie anti-thrombotique Trithérapie anti-thrombotique Critère Secondaire : décès, IDM, reprise ATL, thrombose de stent Décès IDM Reprise ATL AVC Thrombose Stent WOEST p = 0,027 p = 0,382 p = 0,876 p = 0,128 p = 0,165 7,3% 6,8% 6,4% 4,7% 3,3% 3,2% 2,9% 2,6% 1,5% 1,1% Dewilde W, et al. ESC 2012

Conclusion 1ère étude d’évaluation du traitement AAP chez les coronariens traités par AVK et justifiant une ATL + Stent La bithérapie anti-thrombotique AVK + clopidogrel entraîne significativement moins de saignements que la trithérapie AVK-aspirine-clopidogrel. Ce bénéfice s’observe sans surcroît d’évènements thrombotiques ou thrombo-emboliques. La mortalité totale est significativement plus faible sous bithérapie. WOEST Dewilde W, et al. ESC 2012