[Optimal duration of dual antiplatelet therapy after coronary stent placement or acute coronary syndrome. Is customisation possible?] / Durée optimale de la double antiagrégation plaquettaire après angioplastie coronaire ou syndrome coronaire aigu. La personnalisation est-elle possible ?

The recommended 6-month dual antiplatelet therapy (DAPT) after coronary angioplasty with implantation of a drug eluting stent is based on solid evidence, but must take into account continuous improvements in stent technology leading to reduced thrombogenicity. In stable patients with a high hemorrhagic risk, it is possible to reduce DAPT duration at 3 months without significant increase in the risks of ischemic events or stent thrombosis. Further reduction toward a 1-month DAPT is likely to involve new strategies of stopping aspirin at 1 month, and continuing long-term monotherapy with inhibitors of P2Y12 receptor. After acute coronary syndrome, it seems possible to reduce the duration of DAPT (standard, 12 months) in patients at high risk of bleeding. A 6-month DAPT, or even less, provides a good compromise between hemorrhagic risk and ischemic recurrences. Conversely, in patients who have fully tolerated a 12-month DAPT after infarction, and who are at very high risk of ischemic recurrence, the prolongation of a P2Y12 inhibitor in combination with aspirin may be considered, with a risk of haemorrhage almost double. A certain degree of customisation of the duration of DAPT is therefore possible, based on age, renal function, comorbidities, haemorrhagic history, and the use of risk scores (PRECISE-DAPT, DAPT).

[Antiplatelet duration in the elderly patients after percutaneous coronary intervention]. / Durée du traitement antiagrégant plaquettaire chez le sujet âgé stenté.

Ischemic heart disease is a leading cause of death in Europe. At the same time, older patients are at high risk for coronary heart disease and represent an increasing proportion of patients in the catheterization laboratory in the context of an ageing population. The elderly patients are also at higher bleeding risk, and were poorly represented in major randomized trials. Duration of dual antiplatelet therapy (DAPT), after percutaneous coronary intervention (PCI) should be modulated in a personalized way taking into account hemorrhagic and ischemic risk factors, using risk scores based on the latest recommendations of the European Society of Cardiology. Even if the optimal duration of DAPT after PCI is 6 months in case of stable coronary disease and 12 months in case of an acute coronary syndrome, it can be drastically reduced, up to one month in case of high hemorrhagic risk, or can be prolonged for more than 12 months in case of high ischemic risk. The use of latest generation drug eluting stents associated with a short duration of DAPT has thus demonstrated its safety compared to these durations. In case of triple therapy treatment, associating DAPT and anticoagulation therapy, DAPT is recommended to be as short as possible, potentially reduced to 1 month. Finally, the concomitant prescription of proton pump inhibitor is essential to prevent gastrointestinal bleedings. This literature review will discuss the hemorrhagic risk stratification and choice of DAPT in elderly patients.

[Acute anterior myocardial infarction as presenting feature of antiphospholipid syndrome related lupus arthritis]. / Infarctus du myocarde antérieur inaugural révélateur d'un syndrome des antiphospholipides dans le cadre d'une polyarthrite lupique.

INTRODUCTION: Antiphospholipid syndrome is an autoimmune disorder causing venous and arterial thrombosis. Acute coronary complications are rare but potentially dramatic. CASE REPORT: We report a 39-year-old woman who presented with an acute anterior myocardial infarction after intravenous corticosteroids as part of the treatment of lupus arthritis and revealing antiphospholipid syndrome. Emergency coronary angiography was performed with drug-eluting stent angioplasty despite the need for anticoagulation and dual antiplatelet therapy. CONCLUSION: Antiplatelet and anticoagulant therapy management is pivotal in patients with antiphospholipid syndrome and acute coronary syndrome to prevent thrombosis recurrence.