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Antiplatelet treatment (platelet aggregation inhibitors) is essential in cardiovascular medicine today. Aspirin and, more recently, clopidogrel are among the most important treatments of cardiovascular diseases. Although the benefit/risk ratio is generally favorable as secondary prevention, and justifies the treatment, it is less so in primary prevention and indeed, sometimes difficult to establish. Although the combination of two treatments seems attractive, it has been shown effective only for some indications. The principal risk of an antiplatelet treatment that inhibits clotting is bleeding, and the risk almost doubles when two treatments are combined. New platelet aggregation inhibitors, undoubtedly more efficacious, but also more likely to induce bleedings, will probably emerge.

Multidetector computed tomography coronarography is a promising tool, offering a non-invasive anatomic evaluation of coronary arteries. The great majority of studies conducted upon it are single-center studies, and have reported results based upon a highly selected patient population. Our aim was to determine its diagnostic accuracy among an unselected population in multicenter studies.Fifty-two patients were included in a non-randomised, retrospective study. Patients underwent multidetector computed tomography coronarography (16, 40 and 64 slices), in ten different centers (community hospitals or private centres), for clinical suspicion of coronary stenoses. The diagnostic accuracy for detecting significant coronary stenoses (or =50%) was determined in comparison with conventional coronarography.The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were 91.4%, 17.7%, 69.6%, 50.0%, and 67.3%, respectively, in a patient-based analysis, and 55.3%, 85.6%, 30.3%, 94.4% and 82.5% in a segment-based analysis.The results of this study indicate that routine implementation of multidetector computed tomography coronarography is limited by a high false-positive rate, when performed among an unselected population of patients with a high pretest probability of having coronary stenoses, in centres with variable expertises. Its place within the range of diagnostic tools has yet to be determined by large multicenter studies, before being subject to precise recommendations framing its routine clinical application.

Oral anticoagulant treatment with vitamin K antagonists (VKA) is prescribed to an increasing number of patients. These drugs are,however, one of the leading causes of iatrogenic disease. It is essential to monitor the intensity of anticoagulation very closely, by a biological measure (INR, international normalized ratio),to minimize the frequency of thrombotic and hemorrhagic events that may occur in the case of insufficient or excessive anticoagulation. Current methods of monitoring INR can be improved.Self-testing of INR and self-monitoring of oral coagulation treatment offer advantages over more conventional approaches. This self-testing can be performed by most patients capable of living alone, regardless of their social status or educational level. Despite the existence of very reliable self-testing devices, France is very far behind in the use of these instruments that allow management and improve the morbidity and mortality inherent in anticoagulant treatment.

Background: there are many differents risk factors of cardiac allograft vasculopathy after heart transplantation. Preformed donor-specific-antibodies (DSA) could be one of them. Objective: to assess the impact of pre-transplant DSA on cardiac allograft vasculopathy development. Methods: we performed an observational, retrospective and single center study. All patients with heart transplantation between 2008 and 2013 with at least one coronary angiography were included. We compared the occurence of moderate or severe cardiac allograft vasculopathy (CAV 2-3) and its evolution (at least +1 point of CAV) in patients with (MFI >1000) and without (MFI < 1000) pretransplant DSA, identified by Luminex single antigen. Results: 287 patients were included. 98 patients had DSA with MFI > 1000, 189 had DSA with MFI < 1000. The median follow-up was 5,17 years. In univariate analysis, DSA were not a significant risk factor of CAV 2-3 (sHR=0,74 ; p=0,37) or evolution of CAV (sHR=0,7 ; p=0,36) neither. Patients with high antibodies level (MFI > 3000) didn’t have more CAV 2-3 (sHR=0,58 ; p=0,47) or evolution of CAV (sHR=0,53 ; p=0,60) neither. Positive risk factors in multivariate analysis were donor’s ones (age, gender, smoking). Conclusion: heart transplantation of patients with pre-transplant DSA does not seem to cause more cardiac allograft vasculopathy.; Introduction : les facteurs de risque de maladie coronaire du greffon après transplantation cardiaque sont multiples. La présence d’anticorps anti-HLA dirigés contre le greffon (DSA) au moment de la greffe en est un très discuté. Objectif : évaluer l’impact de la présence d’anticorps préformés sur le développement d’une forme précoce de coronaropathie du greffon. Méthode : nous avons mené une étude observationnelle rétrospective monocentrique. Nous avons inclus les patients transplantés cardiaques entre 2008 et 2013 ayant eu au moins une coronarographie. Nous avons comparé la survenue d’une maladie coronaire du greffon modérée à sévère (CAV 2-3) et son évolution (+1 point au moins de CAV), chez les patients avec DSA (MFI>1000) et sans DSA (MFI 1000, et 189 n’en possédaient pas. Le suivi médian a été de 5,17 ans. En analyse univariée, les anticorps préformés n’étaient pas un facteur de risque significatif de survenue d’une CAV 2-3 (sHR=0,74 ; p=0,37) ni d’évolution de CAV (sHR=0,7 ; p=0,36). Un taux d’anticorps élevé (MFI > 3000) n’avait pas non plus d’influence sur la survenue d’une CAV 2-3 (sHR=0,58 ; p=0,47) ni sur son évolution (sHR=0,53 ; p=0,60). Les facteurs de risque positifs en analyse multivariée étaient ceux liés au donneur (âge, sexe, tabagisme). Conclusion : la transplantation cardiaque des patients présentant préalablement des anticorps anti- HLA ne semble pas provoquer de maladie coronaire du greffon supplémentaire.