According to current guidelines and clinical practice, PCI patients already taking an oral anticoagulant generally end up on triple therapy comprising the anticoagulant plus clopidogrel and aspirin. However, there is no supporting evidence base for this approach, and the triple-therapy regimen is known to increase bleeding complications. Now a new study — the first randomized trial to address this situation, according to the investigators — may have a large impact on clinical practice by demonstrating that the omission of aspirin in this context appears to be safe and may reduce adverse events.<\/p>\n
Results of the WOEST (What Is the Optimal Antiplatelet and Anticoagulant Therapy in Patients with Oral Anticoagulantion and Coronary Stenting) trial were presented by Willem Dewilde at the ESC in Munich today. Investigators in the Netherlands and Belgium randomized 573 patients to triple therapy or dual therapy of an anticoagulant\u00a0plus clopidogrel for at least 1 month after implantation of a bare-metal stent or 1 year after a drug-eluting stent. Two thirds of the patients were receiving oral anticoagulation for atrial fibrillation.<\/p>\n
The primary endpoint, the incidence of all bleeding events, was dramatically reduced in the dual-therapy group at 1 year:<\/p>\n
There were three intracranial bleeds in each group. Most of the difference in bleeding occurred in TIMI minor and minimal bleeding. The difference in TIMI major bleeding (3.3% vs. 5.8%) did not achieve statistical significance.<\/p>\n
Clinical events, the trial’s secondary endpoint, were numerically lower in the dual-therapy group. The difference in mortality achieved statistical significance.<\/p>\n