The WOEST study found a significant reduction in bleeding complications post PCI with oral anticoagulation indication (OAC) when treating patients with dual antiplatelet therapy (DAPT) vs. the triple antithrombotic scheme. Several randomized studies have shown these results. At present, the guidelines recommend using the triple antithrombotic scheme in patients according to ischemic and bleeding risk.
The WOEST 2 is a prospective multicenter registry aiming at assessing the use, efficacy, and safety of the combined use of OAC and antiplatelet antiaggregants after PCI in the real world.
Safety primary end point was clinically relevant bleeding by BARC criteria. Efficacy primary end point was MACCE which included all cause death, AMI, stent thrombosis, ischemic stroke, and transient ischemic attack. Secondary end point included bleeding and ischemic events.
1058 patients were included. Mean age was 74 and 24% were women. El 87% of patients were already on anticoagulants. The most frequently used were NOACS (53,1%), Rivaroxaban in particular. Clopidogrel was the most used antiplatelet. The most frequent presentation of patients undergoing PCI was ACS.
At discharge, DAPT was indicated to 644 patients, while the remaining 414 were indicated the triple scheme. Patients receiving DAPT had more hypertension, prior stroke, stroke, cardiac failure and atrial fibrillation.
Read also: Ticagrelor Shows Benefits in Coronary Microvascular Function after NSTEMI.
As regards the primary end point, the use of DAPT at discharge was associated with significant reduction of clinically relevant bleeding at one year vs. the use of the triple scheme (16.8% vs 23.6%; p=0.003). This difference was also observed when adjusting variables. However, there were no differences in major bleeding or hemorrhagic stroke.
Looking at efficacy, researchers observed a higher rate of MACCE in the DAPT group at the expense of higher AMI rate, stent thrombosis and all cause death. However, this difference was not statistically relevant.
Conclusion
In this prospective study of the real world, DAPT vs the triple antithrombotic scheme in patients with atrial fibrillation or mechanical valve prosthesis, showed lower risk of clinically relevant bleeding with no significant increase of ischemic events.
Dr. Andrés Rodríguez
Member of the editorial board in SOLACI.org .
Original Title: Dual versus triple antithrombotic therapy after percutaneous coronary intervention: the prospective multicentre WOEST 2 Study.
Reference: Willem Lambertus , MD et al EuroIntervention 2022;17.
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