[The best of thrombosis in 2005]

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.