Aspirin Twice a Day in Patients With Diabetes and Acute Coronary Syndrome

Prior treatment

• Concomitant anticoagulation therapy that cannot be stopped
• Fibrinolytic therapy less than 24 hours.
• Previous hemorrhagic stroke, previous cranial bleeding, intracranial neoplasia, arterio-venous malformation
• Concomitant treatment with methotrexate or with chronic non-steroidal anti-inflammatory drug
• Participant in an another investigational drug study within 30 days

Other illness

• Allergy or contraindication to aspirin (Hypersensitivity to aspirin or any of the excipients, history of asthma induced by the administration of salicylates, ongoing peptic ulcer, constitutional or acquired haemorrhagic disease including gastrointestinal bleeding, history of hemorrhagic stroke and thrombocytopenia, pregnancy after 24 weeks of gestation, risk of bleeding, severe renal failure, severe hepatic impairment, uncontrolled severe heart failure
• Known serious hematological disorder
• Proven gastric or duodenal ulcer in the past 3 months
• Any condition that may put the patient at risk or influence study result in the investigators' opinion (active cancer ….) or that increase the risk for non-compliance or being lost to follow-up

Age

• Pregnancy or lactation or woman of childbearing age without contraception

Other

• Unstable patients according to investigator: use of amine or mechanical device (IABP, ECMO or similar) or mechanical ventilation during index hospitalization
• Index event is an acute complication of coronary revascularization (PCI or CABG)
• Patients under curatorship
• No social security

• Diabetes mellitus defined as (≥ 1 item)
  • Treated diabetes mellitus
  • 2 fasting glucose levels ≥ 7 mmol/l after admission
  • glucose level ≥ 11 mmol/l after admission (any moment)
  • HbA1C ≥ 6.5% OR
• Factor of aspirin lack of efficacy defined as (≥ 1 item)
  • Obesity defined as BMI≥27kg/m2
  • Waist circumference ≥ 88cm for women or ≥102cm for men
  • Index event occurring under chronic low dose of aspirin (\<300mg)
  • AND
  • \- Acute coronary syndrome defined as:
• Acute coronary syndrome with ST-segment elevation (STEMI) is defined as chest pain (≥ 30min) with persistent ST-segment elevation in at least two contiguous leads (≥1mm) or a new left bundle-branch block and the intention to perform primary PCI or thrombolysis.
• Acute coronary syndrome without ST-segment elevation (NSTEMI) is defined as universal myocardial definition:
  • Detection of cardiac biomarker values elevation \[preferably cardiac troponin (cTn)\] with at least one value above the 99th percentile upper reference limit (URL) and with at least one of the following:
• Symptoms of ischemia
• New or presumed new significant ST-segment-T wave (ST-T) changes except ST elevation
• Development of pathological Q waves in the ECG
• Imaging evidence of new loss of viable myocardium or new regional wall motion abnormality
• Identification of an intracoronary thrombus by angiography
  • included after the angiography showing stenosis ≥50% and before discharge
  • signed informed consent and ≥18 years old