Skip to main content
SpringerLink
Log in

Traitements antiplaquettaire et anticoagulant des syndromes coronariens aigus

Antiplatelet and anticoagulation treatments in acute coronary syndromes

  • Mise au Point / Update
  • Published:
Réanimation

Résumé

Les antithrombotiques ont une place essentielle dans le traitement des syndromes coronariens aigus (SCA). Différentes associations d’antiplaquettaires et d’anticoagulants sont possibles. Les traitements antithrombotiques les plus puissants réduisent la survenue des événements ischémiques, mais augmentent les complications hémorragiques. Trouver le point d’équilibre entre les deux risques est un des défis de la prise en charge des SCA.

Abstract

Antithrombotic therapy is an essential part of the management of acute coronary syndromes. Therapy with numerous combinations of antiplatelet and anticoagulant drugs is possible. In general, a more potent antithrombotic effect is associated with a decreased risk of ischemic events but an increased risk of bleeding. Finding the right balance remains a major challenge.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Références

  1. Thygesen K, Alpert JS, Jaffe AS, et al (2012) Third universal definition of myocardial infarction. Eur Heart J 33:2551–67

    Article  PubMed  Google Scholar 

  2. Meadows TA, Bhatt DL (2007) Clinical aspects of platelet inhibitors and thrombus formation. Circ Res 100:1261–75

    Article  CAS  PubMed  Google Scholar 

  3. Authors/Task Force Members, Roffi M, Patrono C, et al (2016) 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 37:267–315

    Article  Google Scholar 

  4. Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA (2014) Antiplatelet and anticoagulation therapy for acute coronary syndromes. Circulation research 114:1929–43

    Article  CAS  PubMed  Google Scholar 

  5. Huber K, Bates ER, Valgimigli M, et al (2014) Antiplatelet and anticoagulation agents in acute coronary syndromes: what is the current status and what does the future hold? Am Heart J 168:611–21

    Article  CAS  PubMed  Google Scholar 

  6. Patrono C, Andreotti F, Arnesen H, et al (2011) Antiplatelet agents for the treatment and prevention of atherothrombosis. Eur Heart J 32:2922–32

    Article  CAS  PubMed  Google Scholar 

  7. Authors/Task Force Members, Windecker S, Kolh P, et al (2014) 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35:2541–619

    Article  Google Scholar 

  8. Andell P, James SK, Cannon CP, et al (2015) Ticagrelor versus clopidogrel in patients with acute coronary syndromes and chronic obstructive pulmonary disease: an analysis from the Platelet Inhibition and Patient Outcomes (PLATO) Trial. J Am Heart Assoc [in press]

    Google Scholar 

  9. Investigators CO, Mehta SR, Bassand JP, et al (2010) Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. New Engl J Med 363:930–42

    Article  Google Scholar 

  10. Antithrombotic Trialists Collaboration (2002) Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high-risk patients. BMJ 324:71–86

    Article  Google Scholar 

  11. Linden MD, Tran H, Woods R, Tonkin A (2012) High platelet reactivity and antiplatelet therapy resistance. Semin Thromb Hemost 38:200–12

    Article  CAS  PubMed  Google Scholar 

  12. Silberman S, Neukirch-Stoop C, Steg PG (2005) Rapid desensitization procedure for patients with aspirin hypersensitivity undergoing coronary stenting. Am J Cardiol 95:509–10

    Article  CAS  PubMed  Google Scholar 

  13. Wong JT, Nagy CS, Krinzman SJ, et al (2000) Rapid oral challenge-desensitization for patients with aspirin-related urticariaangioedema. J Allergy Clin Immunol 105:997–1001

    Article  CAS  PubMed  Google Scholar 

  14. Schiano P, Steg PG, Barbou F, Monsegu J (2012) A strategy for addressing aspirin hypersensitivity in patients requiring urgent PCI. Eur Heart J Acute Cardiovasc Care 1:75–8

    PubMed  PubMed Central  Google Scholar 

  15. Dewilde WJ, Oirbans T, Verheugt FW, et al (2013) Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 381:1107–15

    Article  CAS  PubMed  Google Scholar 

  16. Mega JL, Braunwald E, Wiviott SD, et al (2012) Rivaroxaban in patients with a recent acute coronary syndrome. New Engl J Med 366:9–19

    Article  CAS  PubMed  Google Scholar 

  17. Task Force on the management of STseamiotESoC, Steg PG, James SK, et al (2012) ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation. Eur Heart J 33:2569–619

    Article  Google Scholar 

  18. Steblovnik K, Blinc A, Bozic-Mijovski M, et al (2015) Platelet reactivity in comatose survivors of cardiac arrest undergoing percutaneous coronary intervention and hypothermia. EuroIntervention 10:1418–24

    Article  PubMed  Google Scholar 

  19. Ibrahim K, Christoph M, Schmeinck S, et al (2014) High rates of prasugrel and ticagrelor non-responder in patients treated with therapeutic hypothermia after cardiac arrest. Resuscitation 85:649–56

    Article  CAS  PubMed  Google Scholar 

  20. Parodi G, Valenti R, Bellandi B, et al (2013) Comparison of prasugrel and ticagrelor loading doses in ST-segment elevation myocardial infarction patients: RAPID (Rapid Activity of Platelet Inhibitor Drugs) primary PCI study. J Am Coll Cardiol 61:1601–6

    Article  CAS  PubMed  Google Scholar 

  21. Yusuf S, Zhao F, Mehta SR, et al (2001) Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. New Engl J Med 345:494–502

    Article  CAS  PubMed  Google Scholar 

  22. Simon T, Verstuyft C, Mary-Krause M, et al (2009) Genetic determinants of response to clopidogrel and cardiovascular events. New Engl J Med 360:363–75

    Article  CAS  PubMed  Google Scholar 

  23. Collet JP, Hulot JS, Pena A, et al (2009) Cytochrome P450 2C19 polymorphism in young patients treated with clopidogrel after myocardial infarction: a cohort study. Lancet 373:309–17

    Article  CAS  PubMed  Google Scholar 

  24. Price MJ, Berger PB, Teirstein PS, et al (2011) Standard- vs. high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention: the GRAVITAS randomized trial. JAMA 305:1097–105

    CAS  PubMed  Google Scholar 

  25. Collet JP, Cuisset T, Range G, et al (2012) Bedside monitoring to adjust antiplatelet therapy for coronary stenting. New Engl J Med 367:2100–9

    Article  CAS  PubMed  Google Scholar 

  26. Agewall S, Cattaneo M, Collet JP, et al (2013) Expert position paper on the use of proton pump inhibitors in patients with cardiovascular disease and antithrombotic therapy. Eur Heart J 34:1708–13, 13a–13b

    Article  PubMed  Google Scholar 

  27. Wiviott SD, Antman EM, Braunwald E (2010) Prasugrel. Circulation 122:394–403

    Article  PubMed  Google Scholar 

  28. Wiviott SD, Braunwald E, Mc Cabe CH, et al (2007) Prasugrel versus clopidogrel in patients with acute coronary syndromes. New Engl J Med 357:2001–15

    Article  CAS  PubMed  Google Scholar 

  29. Montalescot G, Wiviott SD, Braunwald E, et al (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–31

    Article  CAS  PubMed  Google Scholar 

  30. Wiviott SD, Braunwald E, Angiolillo DJ, et al (2008) Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38. Circulation 118:1626–36

    Article  CAS  PubMed  Google Scholar 

  31. Wallentin L, Becker RC, Budaj A, et al (2009) Ticagrelor versus clopidogrel in patients with acute coronary syndromes. New Engl J Med 361:1045–57

    Article  CAS  PubMed  Google Scholar 

  32. Held C, Asenblad N, Bassand JP, et al (2011) Ticagrelor versus clopidogrel in patients with acute coronary syndromes undergoing coronary artery bypass surgery: results from the PLATO (Platelet Inhibition and Patient Outcomes) trial. J Am Coll Cardiol 57:672–84

    Article  CAS  PubMed  Google Scholar 

  33. Storey RF, Becker RC, Harrington RA, et al (2011) Characterization of dyspnoea in PLATO study patients treated with ticagrelor or clopidogrel and its association with clinical outcomes. Eur Heart J 32:2945–53

    Article  CAS  PubMed  Google Scholar 

  34. Steg PG, Bhatt DL, Hamm CW, et al (2013) Effect of cangrelor on periprocedural outcomes in percutaneous coronary interventions: a pooled analysis of patient-level data. Lancet 382:1981–92

    Article  CAS  PubMed  Google Scholar 

  35. Montalescot G, Bolognese L, Dudek D, et al (2013) Pretreatment with prasugrel in non-ST-segment elevation acute coronary syndromes. New Engl J Med 369:999–1010

    Article  CAS  PubMed  Google Scholar 

  36. Montalescot G, Collet JP, Ecollan P, et al (2014) Effect of prasugrel pre-treatment strategy in patients undergoing percutaneous coronary intervention for NSTEMI: the ACCOAST-PCI study. J Am Coll Cardiol 64:2563–71

    Article  CAS  PubMed  Google Scholar 

  37. Donataccio MP, Puymirat E, Vassanelli C, et al (2014) Presentation and revascularization patterns of patients admitted for acute coronary syndromes in France between 2004 and 2008 (from the National Observational Study of Diagnostic and Interventional Cardiac Catheterization [ONACI]). Am J Cardiol 113:243–8

    Article  PubMed  Google Scholar 

  38. Collet JP, Silvain J, Bellemain-Appaix A, Montalescot G (2014) Pretreatment with P2Y12 inhibitors in non-ST-Segment-elevation acute coronary syndrome: an outdated and harmful strategy. Circulation 130:1904–14

    Article  PubMed  Google Scholar 

  39. Alexopoulos D, Bhatt DL, Hamm CW, et al (2015) Early P2Y12 inhibition in ST-segment elevation myocardial infarction: bridging the gap. Am Heart J 170:3–12

    Article  CAS  PubMed  Google Scholar 

  40. Montalescot G, van’t Hof AW, Lapostolle F, et al (2014) Prehospital ticagrelor in ST-segment elevation myocardial infarction. New Engl J Med 371:1016–27

    Article  PubMed  Google Scholar 

  41. Mauri L, Kereiakes DJ, Yeh RW, et al (2014) Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. New Engl J Med 371:2155–66

    Article  PubMed  PubMed Central  Google Scholar 

  42. Palmerini T, Benedetto U, Bacchi-Reggiani L, et al (2015) Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials. Lancet 385:2371–82

    Article  CAS  PubMed  Google Scholar 

  43. Elmariah S, Mauri L, Doros G, et al (2015) Extended duration dual antiplatelet therapy and mortality: a systematic review and meta-analysis. Lancet 385:792–8

    Article  PubMed  PubMed Central  Google Scholar 

  44. Navarese EP, Andreotti F, Schulze V, et al (2015) Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials. BMJ 350:h1618

    Article  PubMed  PubMed Central  Google Scholar 

  45. Fifth Organization to Assess Strategies in Acute Ischemic Syndromes I, Yusuf S, Mehta SR, et al (2006) Comparison of fondaparinux and enoxaparin in acute coronary syndromes. New Engl J Med 354:1464–76

    Article  Google Scholar 

  46. Group FO-T, Steg PG, Jolly SS, et al (2010) Low-dose vs. standarddose unfractionated heparin for percutaneous coronary intervention in acute coronary syndromes treated with fondaparinux: the FUTURA/OASIS-8 randomized trial. JAMA 304:1339–49

    Google Scholar 

  47. Montalescot G, Zeymer U, Silvain J, et al (2011) Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the International randomised open-label ATOLL trial. Lancet 378:693–703

    Article  CAS  PubMed  Google Scholar 

  48. American College of Emergency P, Society for Cardiovascular A, Interventions, O’Gara PT, et al (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 61:e78–e140

    Google Scholar 

  49. Stone GW, Mc Laurin BT, Cox DA, et al (2006) Bivalirudin for patients with acute coronary syndromes. New Engl J Med 355:2203–16

    Article  CAS  PubMed  Google Scholar 

  50. Stone GW, Witzenbichler B, Guagliumi G, et al (2008) Bivalirudin during primary PCI in acute myocardial infarction. New Engl J Med 358:2218–30

    Article  CAS  PubMed  Google Scholar 

  51. Steg PG, van’ t Hof A, Hamm CW, et al (2013) Bivalirudin started during emergency transport for primary PCI. New Engl J Med 369:2207–17

    Article  CAS  PubMed  Google Scholar 

  52. Shahzad A, Kemp I, Mars C, et al (2014) Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single centre, randomised controlled trial. Lancet 384:1849–58

    Article  CAS  PubMed  Google Scholar 

  53. Valgimigli M, Frigoli E, Leonardi S, et al (2015) Bivalirudin or unfractionated heparin in acute coronary syndromes. New Engl J Med 373:997–1009

    Article  CAS  PubMed  Google Scholar 

  54. Greinacher A (2015) Clinical practice. Heparin-induced thrombocytopenia. New Engl J Med 373:252–61

    Article  CAS  PubMed  Google Scholar 

  55. Steg PG, Bonnefoy E, Chabaud S, et al (2003) Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 108:2851–6

    Article  PubMed  Google Scholar 

  56. Alexander JH, Lopes RD, James S, et al (2011) Apixaban with antiplatelet therapy after acute coronary syndrome. New Engl J Med 365:699–708

    Article  CAS  PubMed  Google Scholar 

  57. Hansen ML, Sorensen R, Clausen MT, et al (2010) Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch Intern Med 170:1433–41

    Article  CAS  PubMed  Google Scholar 

  58. Lip GY, Windecker S, Huber K, et al (2014) Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Eur Heart J 35:3155–79

    Article  PubMed  Google Scholar 

  59. European Heart Rhythm A, European Association for Cardio- Thoracic S, Camm AJ, et al (2010) Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 31:2369–429

    Article  Google Scholar 

  60. Stefanini GG, Holmes DR (2013) Drug-eluting coronary-artery stents. New Engl J Med 368:254–65

    Article  CAS  PubMed  Google Scholar 

  61. Valgimigli M, Patialiakas A, Thury A, et al (2015) Zotarolimuseluting versus bare-metal stents in uncertain drug-eluting stent candidates. J Am Coll Cardiol 65:805–15

    Article  CAS  PubMed  Google Scholar 

  62. Pisters R, Lane DA, Nieuwlaat R, et al (2010) A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest 138:1093–100

    Article  PubMed  Google Scholar 

  63. Fiedler KA, Maeng M, Mehilli J, et al (2015) Duration of triple therapy in patients requiring oral anticoagulation after drugeluting stent implantation: The ISAR-TRIPLE Trial. J Am Coll Cardiol 65:1619–29

    Article  PubMed  Google Scholar 

  64. Gibson CM, Mehran R, Bode C, et al (2015) An open-label, randomized, controlled, multicenter study exploring two treatment strategies of rivaroxaban and a dose-adjusted oral vitamin K antagonist treatment strategy in subjects with atrial fibrillation who undergo percutaneous coronary intervention (PIONEER AFPCI). Am Heart J 169:472–8 e5

    Article  CAS  PubMed  Google Scholar 

  65. Doyle BJ, Rihal CS, Gastineau DA, Holmes DR Jr (2009) Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervention: implications for contemporary practice. J Am Coll Cardiol 53:2019–27

    Article  PubMed  Google Scholar 

  66. Subherwal S, Bach RG, Chen AY, et al (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) Bleeding Score. Circulation 119:1873–82

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de cardiologie GHIRM, 10, rue du Général-Leclerc, F-93370, Montfermeil, France

    O. Nallet, J. Pascal & D. Millischer

Authors
  1. O. Nallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Pascal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Millischer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to O. Nallet.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Nallet, O., Pascal, J. & Millischer, D. Traitements antiplaquettaire et anticoagulant des syndromes coronariens aigus. Réanimation 25, 155–167 (2016). https://doi.org/10.1007/s13546-016-1177-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13546-016-1177-4

Mots clés

Keywords

Search

Navigation