title: Uninterrupted oral anticoagulation versus bridging in patients with long-term oral anticoagulation during percutaneous coronary intervention: subgroup analysis from the WOEST trial.
abstract: OBJECTIVE
  To investigate the optimal periprocedural antithrombotic strategy in patients on long-term oral anticoagulation (OAC) who require percutaneous coronary intervention with stenting.
  
  
  RESULTS
  The WOEST study was a randomised controlled trial which recruited 573 patients on long-term OAC who underwent PCI. The periprocedural treatment strategy was left to the operator's discretion. To assess the safety and feasibility of uninterrupted oral anticoagulation (UAC) and bridging therapy (BT), bleeding complications and MACCE were assessed in patients treated according to UAC (n=241) and BT (n=322) regimen. After 30 days, as well as after one year, there were no significant differences in bleeding complications (HR 1.14, 95% CI: 0.77-1.69, p=0.51, and HR 1.26, 95% CI: 0.94-1.69, p=0.12, respectively) and MACCE. MACCE tended to be less frequent in the UAC group (respectively HR 0.48, 95% CI: 0.15-1.51, p=0.21, and HR 0.72, 95% CI: 0.46-1.14, p=0.16). Additionally, adjustment with a propensity score revealed no significant differences. Periprocedural INR was not associated with bleeding or MACCE.
  
  
  CONCLUSIONS
  In the WOEST study, UAC was not associated with an increase of bleeding or MACCE compared to bridging therapy. This is the largest study up to now to support the current guidelines. The WOEST trial is registered with ClinicalTrials.gov, number NCT00769938.
authors: Department of Cardiology, Amphia Hospital, Breda, The Netherlands.
authors: Willem J M
authors: WJ
authors: Dewilde
authors: Paul W
authors: PW
authors: Janssen
authors: Johannes C
authors: JC
authors: Kelder
authors: Freek W A
authors: FW
authors: Verheugt
authors: Bart J G L
authors: BJ
authors: De Smet
authors: Tom
authors: T
authors: Adriaenssens
authors: Mathias
authors: M
authors: Vrolix
authors: Guus B
authors: GB
authors: Brueren
authors: Carlos
authors: C
authors: Van Mieghem
authors: Kristoff
authors: K
authors: Cornelis
authors: Jeroen
authors: J
authors: Vos
authors: Nicoline J
authors: NJ
authors: Breet
authors: Jurriën M
authors: JM
authors: ten Berg
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D003328:Coronary Thrombosis / Q000209:etiology / Q000517:prevention & control; D004334:Drug Administration Schedule; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011237:Predictive Value of Tests; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents