WOEST: Dual antiplatelet therapy more effective than triple

Dual antiplatelet therapy with clopidogrel and an oral anticoagulant reduces bleeding and mortality more effectively than triple therapy including aspirin, researchers say.

The results of the What is the Optimal Antiplatelet and Anticoagulant Therapy in Patients with Oral Anticoagulation and Coronary Stenting (WOEST) trial were presented at the European Society of Cardiology Congress in Munich, Germany, by William Dewilde (TweeSteden Hospital, Tilburg, the Netherlands).

He told the press: "WOEST is the first study demonstrating that the omission of aspirin in patients treated with oral anticoagulants and having a coronary stent is safe."

The WOEST trial showed that 1 year after coronary stenting, patients who received dual therapy with clopidogrel 75 mg in addition to an oral anticoagulant daily had a significant 64% lower risk for bleeding than those on triple therapy (clopidogrel 75 mg and aspirin 80 mg in addition to oral anticoagulant daily).

Only 19.5% of dual-therapy patients experienced bleeding compared with 44.9% of patients on triple therapy.

Dual-therapy patients also had a significant 61% lower risk for overall mortality than triple-therapy patients, at a mortality rate of 2.6% versus 6.4%.

Furthermore, there was no significant difference in the rate of myocardial infarction, target vessel revascularization, or stent thrombosis between the dual- and triple-therapy groups.

The study included 573 patients on oral anticoagulant therapy who underwent coronary stenting between 2008 and 2011.

"The WOEST study demonstrates that omitting aspirin leads to less bleeding but does not increase the risk of stent thrombosis, stroke, or myocardial infarction," explained Dewilde.

"Although the number of patients in the trial is limited, this is an important finding with implications for future treatment and guidelines in this group of patients known to be at high risk of bleeding and thrombotic complication."

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