WOEST Trial Finds Clopidogrel Administered Without Aspirin Reduces Bleeding

In patients receiving oral anticoagulants and undergoing percutaneous coronary intervention (PCI), use of clopidogrel without aspirin was found to be associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events, according to a study published on Feb. 13 in The Lancet.

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The year results from the WOEST trial, an open-label multicenter, randomized, controlled trial, looked at 573 patients receiving anticoagulants and undergoing PCI, and showed that bleeding episodes were seen in 54 patients assigned to clopidogrel alone, and in 126 patients receiving clopidogrel plus aspirin (hazard ration [HR] 0. 36, 95 percent CI 0. 26 – 0. 50, p<0.0001). In the patients receiving clopidogrel alone, six patients had multiple bleeding events, compared with 34 patients receiving clopidogrel plus aspirin. Further, 11 patients who received clopidogrel alone required at least one blood transfusion, compared with 27 patients who received clopidogrel plus aspirin (odds ratio from Kaplan-Meier curve 0.39, 95 percent CI 0. 17 – 0.84, p=0.011).

The authors note that the trial "clearly shows that clopidogrel alone administered to patients taking oral anticoagulants who require PCI is associated with a significantly lower rate of bleeding complications at one year than is use of clopidogrel plus aspirin." They add that, "although the trial was small, we saw no evidence of an increased risk of thrombotic events by withholding of aspirin."

Clinical Topics: Invasive Cardiovascular Angiography and Intervention

Keywords: Blood Transfusion, Ticlopidine, Hemorrhage, Percutaneous Coronary Intervention

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