Clopidogrel without aspirin in patients on warfarin undergoing percutaneous coronary intervention

File:PTCA stent NIH.gif

This is an article from a few months ago but one that needs to go in the archive – a patient already on warfarin (say for AF or a mechanical heart valve) comes to you and requires percutaneous coronary intervention. Do you put them on aspirin and clopidogrel, or just either agent on its own, in addition to the warfarin? The WOEST study looks at this.

Dewilde and colleagues performed an RCT across 15 centres in Belgium and the Netherlands, between the Novembers of 2008 and 2011.  These were all patients receiving PCI (with about a quarter being those with acute coronary syndromes), except those in cardiogenic shock, or with either a recent (within 6 months) peptic ulcer, major bleeding previously, or platelet count < 50. Anticoagulation was continued periprocedurally, with a target INR of 2. The majority of patents were done with femoral access, with around 25% using the radial approach. A mix of drug eluting and bare metal stents were also included.

Overall, there was significantly less bleeding in the triple therapy group, with no significant increased thrombotic risk. A great practical article, and definitely worth a read. Check it out here.

source | The Lancet

image | National Institute of Health, via Wikimedia Commons

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