THE WOEST STUDY: IS NOW THE TIME TO UPDATE THE RECOMMENDATIONS REGARDING THE ANTITHROMBOTIC THERAPY IN PATIENTS WITH INDICATION FOR ORAL ANTICOAGULATION UNDERGOING CORONARY STENT IMPLANTATION?

Triple therapy (TT) of warfarin, aspirin, and clopidogrel is currently recommended as the antithrombotic therapy for patients with an indication for oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) with stent implantation (PCI). While appearing to be the most effective regimen in preventing the combined incidence of stroke, death, myocardial infarction, re-revascularisation, and stent thrombosis, TT is however associated with an increased incidence of bleeding. In the recent ‘What is the Optimal antiplatElet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing’ (WOEST) study, dual therapy (DT) with warfarin and clopidogrel has been shown to be significantly safer than TT on the occurrence of total bleeding, with no decrease in efficacy, as the combined incidence of stroke, death, myocardial infarction, re-revascularisation, and stent thrombosis was also significantly lower. Owing to the limited effect of DT on the occurrence of clinically major bleeding, as well as to the large undersizing of the WOEST study for a reliable evaluation of the effect on adverse cardiac events, and especially stent thrombosis, the results of the WOEST study should not yet prompt the substitution of TT for DT as the antithrombotic regimen for patients with an indication for OAC who are submitted to PCI.