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.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

acs/nste-acsatrial fibrillationbleedingclinical researchstable anginastent thrombosis
Read next article
Impact of percutaneous coronary intervention of chronic total occlusions on absolute perfusion in remote myocardium

Latest news