Florence LECLERCQ CHU Montpellierhightech-cardio.org/usrfile/Presentation/2018/OC-IN016.pdf ·...
Transcript of Florence LECLERCQ CHU Montpellierhightech-cardio.org/usrfile/Presentation/2018/OC-IN016.pdf ·...
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Ce qui pourrait changer mes pratiques…. ou pas !
Florence LECLERCQ
CHU Montpellier
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« WOEST »
« ATLAS »
« Guidelines »
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Avant PIONEER ?
Ce qui pourrait changer mes pratiques…. ou pas !
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Fiedler KA et al. JACC 2015;65: 1619-29
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Les guidelines 2016
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Après PIONEER ?
Ce qui pourrait changer mes pratiques…. ou pas !
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Une confirmation des résultats
N Engl J Med 2017; 377:1513-1524
Dual Antithrombotic Therapy without aspirin is safe
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La validation d’un concept: blocage de la thrombine (anti Xa) chez le coronarien (PIONEER, ATLAS, GEMINI ACS, COMPASS)
rivaroxaban
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Un intérêt spécifique de l’AOD
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De nouvelles recommandations ESC 2017
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Ce qui a changé ma pratique
• PIONEER AF-PCI nous montre que l’association du rivaroxaban 15 mg à une inhibiteur du P2Y12 ou de rivaroxaban 2.5mg X2 à la DAPT diminue les complications hémorragiques comparée à la stratégie classique de trithérapie utilisant un AVK
• Valide le concept de l’association d’un antithrombotique et d’un AAP avec suppression possible de l’aspirine après angioplastie et FA
• Nouvelle approche de choix chez les patients à risque
hémorragique élevé dans les guidelines 2017
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Ce que PIONEER ne nous dit pas
• Place de la bithérapie antithrombotique (AC et inhibiteur P2Y12) chez les patients à risque ischémique élevé ?
• Place des « nouveaux » AAP dans la bithérapie?
• Stratégie thérapeutique « à la carte » après 12 mois ?