WOEST Trial: clopidogrel ± aspirin in patients taking PO anticoagulants and undergoing PCI

WOEST Trial Summary:

The WOEST trial was a multicenter, open-label, randomized, controlled clinical trial to assess if clopidogrel alone could reduce bleeding risk compared to clopidogrel plus aspirin in 563 patients. These 563 patients had an indication for a ≥1 year of oral anticoagulant (OAC) and required percutaneous coronary intervention for a severe coronary lesion. 279 patients were given double therapy (clopidogrel plus an OAC) for 1 year, whereas 284 patients were given triple therapy (clopidogrel plus aspirin plus an OAC) for 1 year. 

Double therapy out performed triple therapy in the main primary and secondary outcomes. For the primary outcome, patients on double therapy had significantly decreased bleeding events after 1 year compared to patients on triple therapy (19.4% vs. 44%; HR 0.36; 95% CI 0.26-0.50; p<0.0001; NNT 4). For a secondary outcome, the patient group on double therapy saw significantly decreased occurrences of death, myocardial infarction, TVR, stroke, or stent thrombosis compared to the patient group on triple therapy (11.1% vs. 17.6%; HR 0.60; 95% CI 0.38-0.94; p=0.025; NNT 15). Further for another secondary outcome, the patient group on double therapy saw decreased occurrences of major TIMI bleeding compared to the patient group on triple therapy (3.2% vs. 5.6%; HR 0.56; 95% CI 0.25-1.27; p=0.159).

The authors concluded that for pateints requiring a PCI on an OAC, clopidogrel (double therapy) alone was associated with a significant reduction in bleeding complications compared to patients receiving clopidogrel and aspirin (triple therapy).   

Key Points:

Clopidogrel + OAC has significantly reduced bleeding complications compared to Clopidogrel + Aspirin + OAC. 

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