[Is withdrawal of antiplatelet therapy necessary prior to skin cancer surgery?]. / L'arrêt d'un traitement antiagrégant plaquettaire est-il nécessaire avant une chirurgie cutanée carcinologique?

AIM: The aim of this study was to assess the value of discontinuing antiplatelet treatment prior to surgery for skin cancer with loss of skin of up to 10 cm in diameter. The study hypothesis postulated equivalence between discontinuation of antiplatelet therapy and continuation of these drugs during the perioperative period with regard to risk of cutaneous complications. PATIENTS AND METHODS: This was a prospective, randomised study comparing two groups of patients on long-term antiplatelet treatment scheduled for surgery for skin carcinoma. In the first group, patients underwent surgery without change to their antiplatelet therapy while in the second, antiplatelet treatment was discontinued and substituted with either flurbiprofen or isocoagulant fractionated heparin or calcium heparin. Sixty patients took part in the study. Statistical analysis using ANOVA and Mann-Whitney non-parametric tests was performed to compare the following variables: age, sex, number of pre- and post-operative consultations, complications (haemorrhage, haematoma, separation and infection) and quality of wound healing. RESULTS: No statistically significant difference was seen between the two groups regarding either complications or quality of wound healing. CONCLUSION: There appear to be no rational grounds for discontinuing antiplatelet therapy in advance of skin cancer surgery involving loss of skin of up to 10 cm in diameter.

[Stratification scores for risk in the context of acute coronary syndromes]. / Scores de stratification du risque et syndromes coronariens aigus.

The patients presenting acute coronary syndrome with or without ST segment elevation form a heterogeneous population and thus the short and long-term risk of death or recurrent ischemic events can vary considerably. During ACS without ST elevation (unstable angina and non-ST elevation MI), the evaluation of risk is an essential step in the management of such patients, because it determines ulterior strategy. This evaluation is simple and reliable, and is principally based on three scores: the TIMI, the GRACE Score or the PURSUIT. Thanks to this stratification, high and medium-risk patients are able to benefit from early invasive management (stents and anti-GPIIb/IIIa) as recent studies have clearly shown. Even if immediate management of patients with non-ST elevation ACS does not take account of risk stratification, using such information in the medium and long-term does help determine the prognosis. Finally, the risk profile score, whatever the score used is today an essential tool, which helps qualify and especially compare patients included in international clinical studies.