title: Antiplatelet therapy strategies after percutaneous coronary intervention in patients needing oral anticoagulation.
abstract: Long-term oral anticoagulant (OAC) and dual-antiplatelet therapy are commonly needed in patients with atrial fibrillation and in patients undergoing percutaneous coronary intervention (PCI), respectively. The combination of atrial fibrillation and PCI is frequent, and leads to a dilemma for antithrombotic therapy, where risk of stroke or stent thrombosis must be balanced with bleeding risk. In the WOEST study, 573 patients on OAC undergoing PCI were randomly assigned to receive clopidogrel alone or clopidogrel plus aspirin. The primary end point was the occurrence of any bleeding episode during 1-year follow-up. Clopidogrel alone administered to patients taking OAC after PCI was associated with a significantly lower rate of bleeding complications than clopidogrel plus aspirin. Moreover, a composite secondary end point of death, myocardial infarction and stent thrombosis was significantly lower in the dual-therapy group compared with the triple-therapy group. In spite of its limitations, the WOEST study constitutes a major breakthrough, showing that long-term aspirin after PCI may be obsolete in certain circumstances. This needs to be confirmed in further studies.
authors.affiliation: Cardiologie, Pôle Cœur Thorax Vasculaire, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Saint Etienne
authors.forename: Denis
authors.initials: D
authors.lastname: Angoulvant
authors.forename: Edouard
authors.initials: E
authors.lastname: Simeon
authors.forename: Laurent
authors.initials: L
authors.lastname: Fauchier
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D001241:Aspirin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D013988:Ticlopidine / Q000031:analogs & derivatives*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin