[Critical reading for studies on antithrombotic medications in acute coronary syndromes]

Numerous studies of anti-thrombotic medications in the treatment of acute coronary syndromes have been published in the past few years. The "technical" quality of these studies is usually good. However, the critical reader must focus on the potential use of the observed differences for his patient. In particular, the judgement criteria chosen and the comparator used as reference treatment must be examined with care. Concerning the judgement criteria, it is often combined; it must therefore be decided which is or are the components of these criteria that are favourably influenced by the treatment. Similarly the clinical relevance of the chosen criteria must be questioned. This leads to a discussion of the substitution criteria. Then the judgement criteria must reflect the risk/benefit ratio: however few studies include haemorrhagic risk in the judgement criteria. The choice of comparator reflects current practice on the one hand, and the necessity to standardise the control group treatment on the other. This can continue for several years after the publication of a study, which brings into question whether the result would be identical taking into account the evolution of current practice. Analysis of anti-thrombotic studies with reference to these two criteria allows recommendations to be made concerning the use of anti-thrombotics in acute coronary syndromes.