The year 2005 was rich in new information. Many articles were published on antithrombotic
therapy, the key stone in the management of several
cardiovascular diseases which are the cardiologists' "daily bread". Antithrombotic treatment is essential in the treatment of patients undergoing interventional coronary procedures. The loading dose of 300 mg
clopidogrel has been questioned. The ARMYDA-2 trial showed that a loading dose of 600 mg of
clopidogrel administered 4 to 8 hours before coronary angioplasty significantly reduced the number of peri-procedural
myocardial infarctions without increasing the risk of
bleeding complications. Other molecules such as
prasugrel could provide an alternative to treatment with
clopidogrel. The results of a phase 2 trial (JUMBO-TIMI 26) comparing
clopidogrel and
prasugrel have opened the way for a large scale phase 3 trial which is currently under way. In
myocardial infarction, the CLARITY-TIMI 28 trial showed that patients under 75 years of age with acute
myocardial infarction of less than 12 hours duration treated with
aspirin and
thrombolytic therapy had better results with respect to the combined criteria of patency of the culprit artery and ischaemic complications with the addition of
clopidogrel. In the CREATE trial, patients with acute
myocardial infarction had a lower mortality and recurrence of
infarction without significantly increasing the risk of
stroke with
reviparin. The development of
ximelagatran has been held up by a potentially serious hepato-toxicity. Two large-scale trials were published this year, one in
atrial fibrillation and the other in
venous thrombosis. In the former, the hypothesis of non-inferiority compared with well conducted oral anticoagulation with
coumadine was supported and, in the latter, the hypothesis of non-inferiority compared with treatment with
enoxaparin followed by
warfarin was also confirmed despite a higher number of coronary events in the xinelagatran group. Another study which merits a citation showed that in patients with a previous history of
aspirin-induced
bleeding ulcers, the association of low dose
aspirin and a
proton pump inhibitor was superior to the prescription of
clopidogrel in the prevention of recurrent
bleeding. A study of the pharmacogenetics of
coumadine and the variability of its dosage was also a valuable contribution. In the field of management of
bleeding, a study demonstrated the potential benefits of treatment with VIIa recombinant factor.