{"id":34689,"date":"2013-02-14T10:32:08","date_gmt":"2013-02-14T15:32:08","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=34689"},"modified":"2013-02-14T10:32:08","modified_gmt":"2013-02-14T15:32:08","slug":"no-aspirin-after-des-is-this-the-wild-wild-woest","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/02\/14\/no-aspirin-after-des-is-this-the-wild-wild-woest\/","title":{"rendered":"No Aspirin After DES? Is This The Wild, Wild WOEST?"},"content":{"rendered":"

Some patients referred for coronary stenting have atrial fibrillation or a mechanical valve, for which they are receiving chronic anticoagulation.\u00a0 Typically, dual antiplatelet therapy (with aspirin and clopidogrel) is prescribed to prevent stent thrombosis, but the combination of chronic anticoagulation and dual antiplatelet therapy is associated with a high risk (4\u201316% annually)\u00a0for fatal and nonfatal bleeding.\u00a0 We\u2019re \u201cshooting from the hip,\u201d since we don\u2019t really know the optimal treatment after coronary stenting in these patients.\u00a0<\/p>\n

To address this issue, the WOEST (W<\/strong>hat is the O<\/strong>ptimal antiplatE<\/strong>let and anticoagulation therapy in patients with oral anticoagulation and coronary S<\/strong>tenT<\/strong>ing)<\/a>\u00a0investigators randomly assigned 573 adults receiving anticoagulation and undergoing PCI to (a) clopidogrel alone (double therapy) or (b) clopidogrel plus aspirin (triple therapy);\u00a0one third\u00a0of the study population received bare-metal stents, and two thirds\u00a0received drug-eluting stents.\u00a0 After\u00a01 year of follow-up, the investigators found that double therapy (clopidogrel without aspirin) was associated with a dramatic reduction in bleeding complications and no increase in the rate of thrombotic events when compared\u00a0with triple therapy<\/em><\/strong>.\u00a0<\/p>\n\n\n\n\n\n\n\n\n\n
\u00a0<\/td>\n\n

Double therapy (n=297)<\/strong><\/p>\n<\/td>\n

\n

Triple Therapy (n=284)<\/strong><\/p>\n<\/td>\n

\n

P value<\/strong><\/p>\n<\/td>\n<\/tr>\n

Any bleeding<\/td>\n\n

19.4%<\/p>\n<\/td>\n

\n

44.4%<\/p>\n<\/td>\n

\n

<0.001<\/p>\n<\/td>\n<\/tr>\n

TIMI bleeding<\/td>\n\n

\u00a0<\/p>\n<\/td>\n

\n

\u00a0<\/p>\n<\/td>\n

\n

\u00a0<\/p>\n<\/td>\n<\/tr>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 major<\/td>\n\n

3.2%<\/p>\n<\/td>\n

\n

5.6%<\/p>\n<\/td>\n

\n

0.159<\/p>\n<\/td>\n<\/tr>\n

–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 major and minor<\/td>\n\n

14.0%<\/p>\n<\/td>\n

\n

31.3%<\/p>\n<\/td>\n

\n

<0.0001<\/p>\n<\/td>\n<\/tr>\n

Transfusions<\/td>\n\n

3.9%<\/p>\n<\/td>\n

\n

9.5%<\/p>\n<\/td>\n

\n

0.011<\/p>\n<\/td>\n<\/tr>\n

Stent Thrombosis<\/td>\n\n

1.4%<\/p>\n<\/td>\n

\n

3.2%<\/p>\n<\/td>\n

\n

0.165<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

In short, the results of the WOEST trial show that aspirin is not needed after coronary stenting in chronically anticoagulated patients treated with clopidogrel.\u00a0 <\/em><\/p>\n

Although the trial was underpowered to detect a difference in the occurrence of stent thrombosis, no suggestion of increased thrombosis in the patients treated with only double therapy was noted.<\/p>\n

What antiplatelet therapy do you prescribe in subjects undergoing coronary stenting who are receiving chronic anticoagulation? <\/em><\/strong><\/p>\n

Based on the results of the WOEST trial, are you willing to prescribe clopidogrel alone to these patients?<\/em><\/strong><\/p>\n

(Although\u00a0just published, the WOEST trial results were\u00a0previously reported by\u00a0Larry Husten\u00a0<\/a>\u00a0after they were presented at the European Society of Cardiology)
\n<\/strong><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

According to the recently published results of the WOEST trial, patients receiving anticoagulation thereapy who undergo stenting have better outcomes with clopidogrel only than with clopidogrel plus aspirin. Rick Lange and David Hillis ask: Are you ready to stop prescribing aspirin to these patients?<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[495,9],"tags":[492,463,301,437,1437],"class_list":["post-34689","post","type-post","status-publish","format-standard","hentry","category-anticoagulation-2","category-interventional-cardiology","tag-anticoagulation","tag-antiplatelet-therapy","tag-pci","tag-stents","tag-woest"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34689","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=34689"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34689\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=34689"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=34689"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=34689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}