Coronary interventions

Dual versus triple antithrombotic therapy after percutaneous coronary intervention: the prospective multicentre WOEST 2 Study

EuroIntervention 2022;18:e303-e313. DOI: 10.4244/EIJ-D-21-00703

Willem Bor
Willem Lambertus Bor1, MD; Anne Johanna Wilhelmina de Veer1, MD; Renske H. Olie2, MD; Sem A.O.F. Rikken1,2, MD; Dean R.P.P. Chan Pin Yin1, MD; Jean Paul R. Herrman3, MD, PhD; Mathias Vrolix4, MD, PhD; Martijn Meuwissen5, MD, PhD; Tom Vandendriessche6, MD; Carlos van Mieghem7,8, MD, PhD; Michael Magro9, MD, PhD; Naoual Bennaghmouch1, MD, PhD; Rick Hermanides10, MD, PhD; Tom Adriaenssens11, MD, PhD; Willem J.M. Dewilde12, MD, PhD; Jurriën Maria ten Berg1,2, MD, PhD
1. Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands; 2. Cardiovascular Research Institute Maastricht (CARIM), School for Cardiovascular Diseases, Maastricht University Medical Center, Maastricht, the Netherlands; 3. Department of Cardiology, OLVG Hospital, Amsterdam, the Netherlands; 4. Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium; 5. Department of Cardiology, Amphia Hospital, Breda, the Netherlands; 6. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium; 7. Cardiovascular Research Center Aalst, OLV Clinic, Aalst, Belgium; 8. Department of Cardiology, AZ Groeninge, Kortrijk, Belgium; 9. Department of Cardiology, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; 10. Department of Cardiology, Isala Hospital, Zwolle, the Netherlands; 11. Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium; 12. Department of Cardiology, Belgium Imelda Hospital, Bonheiden, Belgium

Background: For patients on oral anticoagulants (OAC) undergoing percutaneous coronary intervention (PCI), European guidelines have recently changed their recommendations to dual antithrombotic therapy (DAT; P2Y12 inhibitor and OAC) without aspirin.

Aims: The prospective WOEST 2 registry was designed to obtain contemporary real-world data on antithrombotic regimens and related outcomes after PCI in patients with an indication for OAC.

Methods: In this analysis, we compare DAT (P2Y12 inhibitor and OAC) to triple antithrombotic therapy (TAT; aspirin, P2Y12 inhibitor, and OAC) on thrombotic and bleeding outcomes after one year. Clinically relevant bleeding was defined as Bleeding Academic Research Consortium classification (BARC) grade 2, 3, or 5; major bleeding as BARC grade 3 or 5. Major adverse cardiac and cerebrovascular events (MACCE) was defined as a composite of all-cause mortality, myocardial infarction, stent thrombosis, ischaemic stroke, and transient ischaemic attack.

Results: A total of 1,075 patients were included between 2014 and 2021. Patients used OAC for atrial fibrillation (93.6%) or mechanical heart valve prosthesis (4.7%). Non-vitamin K oral anticoagulants (NOAC) were prescribed in 53.1% and vitamin K antagonists in 46.9% of patients. At discharge, 60.9% received DAT, and 39.1% TAT. DAT was associated with less clinically relevant and similar major bleeding (16.8% vs 23.4%; p<0.01 and 7.6% vs 7.7%, not significant), compared to TAT. The difference in MACCE between the two groups was not statistically significant (12.4% vs 9.7%; p=0.17). Multivariable adjustment and propensity score matching confirmed these results.

Conclusions: Dual antithrombotic therapy is associated with a substantially lower risk of clinically relevant bleeding without a statistically significant penalty in ischaemic events.

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acs/nste-acsatrial fibrillationbleedingclinical researchstable anginastent thrombosis
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