[Acute coronary syndrome: Is there a place for direct oral anticoagulants?]
Venous thromboembolism and atrial fibrillation are two important indications of direct oral anticoagulants. Acute coronary syndrome is another potential indication of prolonged antithrombotic therapy in addition to antiplatelet therapy. Phase 2 and 3 studies were conducted with different molecules at different doses in acute coronary syndrome in addition to dual antiplatelet therapy. Studies have not shown a reduction of ischemic events for dabigatran and apixaban, but an excess of bleeding complications was observed. A reduction of ischemic events and stent thrombosis was observed with low dose of rivaroxaban taken twice a day but with an increased risk of major bleeding complications. This data was used to obtain a European marketing authorization but the positioning of the molecule remains difficult. A new study is currently being conducted to test rivaroxaban in association with a P2Y12 inhibitor without aspirin. Direct oral anticoagulants can also be used after percutaneous coronary intervention in patients requiring long-term oral anticoagulants. Dedicated studies are currently being conducted to confirm the optimal doses and the ideal association of antithrombotic drugs.
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France. Electronic address: cayla.guillaume@gmail.com.
Guillaume
G
Cayla
CHU de Montpellier, université de Montpellier, service de cardiologie, 34090 Montpellier, France.
Florence
F
Leclercq
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France.
Laurent
L
Schmutz
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France.
Luc
L
Cornillet
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France.
Bertrand
B
Ledermann
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France.
Patrick
P
Messner
CHU de Nîmes, université de Montpellier, service de cardiologie, place du Pr Debré, 30029 Nîmes cedex, France.
Benoit
B
Lattuca
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D006801:Humans; D000069552:Rivaroxaban
D000925:Anticoagulants; D000069552:Rivaroxaban