[The best of thrombosis in 2006]

The year 2006 was an excellent year for trials publications on antithrombotic treatments. The results of several important trials were published. Firstly, two new antithrombotic molecules, fondaparinux (anti-Xa) and bivalirudine (anti-IIa), were the object of large scale trials, in coronary artery disease. Fondaparinux, in the OASIS-5 study, was compared with the reference treatment by enoxaparin. The efficacy was equivalent in the treatment of acute coronary syndromes without ST elevation, in the reduction of ischaemic events and, above all, was associated with a reduction in severe bleeding complications and reduced mortality at 9 days and 6 months. The ISAR-REACT 2 trial demonstrated the value of abciximab, a platelet membrane glycoprotein inhibitor, in the treatment of high risk acute coronary syndromes identified by the risk in troponin levels. The ACUITY trial showed that bivalirudine was as effective as abciximab in the treatment of acute coronary syndromes in terms of prevention of ischaemic events and that it reduced the number of bleeding complications. The CHARISMA trial looked at the possible benefit of biotherapy with clopidogrel and aspirin versus monotherapy with aspirin alone in a large panel of high cardiovascular risk patients. The globally negative results should, however, be closely analysed because some subgroups (symptomatic patients) were identified, in which a possible benefit was observed in contrast to other subgroups (multiple risk factors) in which biotherapy appeared to be deleterious. The results of other less publicised trials (STEEPLE, FIDO, ESPRIT) are also commented.