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Aspirin Not Preferred for PCI Patients Undergoing Anticoagulation Therapy

By jeremyc | February 28, 2013

The WOEST trial results have recently been published, and they reaffirm the major finding of the study, which is that treatment with only clopidogrel is preferred over using aspirin and clopidogrel for Percutaneous Coronary Intervention or PCI in patients undergoing oral anticoagulant therapy.

According to the published results, prescribing clopidogrel alone in this kind of situation offers adequate protection against any thrombotic events and also reduces the risk of bleeding that is commonly associated with antiplatelet therapies over oral anticoagulation.

The findings of the WOEST trial are markedly different from the recommendations followed in Europe and the United States based on expert opinion. The present recommendation is that patients who are undergoing long-term oral anticoagulant therapy and PCI should be prescribed a triple therapy of an oral anticoagulant, clopidogrel, and aspirin.

The WOEST trial results had been provisionally published in September 2012 at the European Society of Cardiology Congress. They have only recently been reported in full by the investigators from Twee Steden Hospital, the Netherlands.

The trial had a total of 573 patients aged between 18 and 80 years who had a severe coronary lesion and long-term indication for oral anticoagulation. All the patients in the study received a daily dose of 75mg clopidogrel, but 285 patients underwent the triple therapy and were prescribed 80-100mg aspirin every day. During the one year follow-up period, 54 patients taking only clopidogrel reported a bleeding episode, while 126 patients undergoing triple therapy reported a similar episode at least once. Only six patients taking clopidogrel alone had more than one bleeding episode, as opposed to the 34 who underwent triple therapy.

Keith Fox from the University of Edinburgh, UK, argued against the results saying that the trial was done with a more aggressive regimen that what is recommended at present, so a higher rate of bleeding episodes is to be expected. However, he also said, “WOEST will certainly stimulate larger confirmatory trials with the aim of defining the optimum balance between too much and too little anticoagulant and antiplatelet therapy in patients who require both forms of treatment.”

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