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

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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