Scribd Logo
Upload

Welcome to Scribd!

  • 2013 - WOEST Trial (Double Vs Triple Therapy) ,, Dewilde,, Et Al.

    Uploaded by

    Alaa
    7 views13 pages
    The WOEST trial was a randomized controlled trial that compared double antiplatelet therapy (oral anticoagulant plus clopidogrel) to triple therapy (oral anticoagulant, aspirin, and clopidogrel) in patients undergoing percutaneous coronary intervention who required oral anticoagulation. The study found that major bleeding events were significantly reduced by 64% in the double therapy group compared to the triple therapy group within 1 year, with no significant difference in the composite efficacy endpoint between the two groups. However, the study had limitations such as its open-label design and lack of placebo control or power to detect differences in stent thrombosis

    Original Description:

    WOEST Trial (Double vs Triple Therapy) Antiplatelet therapy

    Original Title

    2013 - WOEST Trial (Double vs Triple Therapy),, Dewilde,, Et Al.

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    The WOEST trial was a randomized controlled trial that compared double antiplatelet therapy (oral anticoagulant plus clopidogrel) to triple therapy (oral anticoagulant, aspirin, and clopidogrel) in patients undergoing percutaneous coronary intervention who required oral anticoagulation. The study found that major bleeding events were significantly reduced by 64% in the double therapy group compared to the triple therapy group within 1 year, with no significant difference in the composite efficacy endpoint between the two groups. However, the study had limitations such as its open-label design and lack of placebo control or power to detect differences in stent thrombosis

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    7 views13 pages

    2013 - WOEST Trial (Double Vs Triple Therapy) ,, Dewilde,, Et Al.

    Uploaded by

    Alaa
    The WOEST trial was a randomized controlled trial that compared double antiplatelet therapy (oral anticoagulant plus clopidogrel) to triple therapy (oral anticoagulant, aspirin, and clopidogrel) in patients undergoing percutaneous coronary intervention who required oral anticoagulation. The study found that major bleeding events were significantly reduced by 64% in the double therapy group compared to the triple therapy group within 1 year, with no significant difference in the composite efficacy endpoint between the two groups. However, the study had limitations such as its open-label design and lack of placebo control or power to detect differences in stent thrombosis

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 13

     Multicenter, open-label, randomized, controlled trial

    Question to be answered!
    *

    Does the usage of single antiplatelets will cause the


    same antithrombotic effect and AT THE SAME TIME
    will reduce the bleeding events associated with Triple
    Antithrombotic Therapy?
    Double Triple
    Vs
    Therapy Therapy

    * Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15.
    doi: 10.1016/S0140-6736(12)62177-1.
    WOEST - Methods

    Triple Therapy
    Double Therapy
    (OAC + P2Y12 inhb. +
    (OAC + P2Y12 inhb.)
    ASA)

    1:1 Assignment
    ≤ 4 hours after PCI.
    Follow-up stopped 1 year after
    inclusion, at the time of death,
    or on Aug 1, 2012, whichever came first.

    Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15.
    doi: 10.1016/S0140-6736(12)62177-1.
    WOEST -
    Indication for oral
    anticoagulation
    Indication for Oral Anticoagulation

    20%
    AFib/AFlut
    Mechanical valve
    Other
    10%

    70%

    Other: PE, PAD, EF<30%, Apical Aneurysm.

    Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy
    and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST – Double Therapy
    CHADS2 score at baseline for AF patients
    CHADS2 score at baseline for AF patients*

    7% 1% 12%
    1
    2
    16%
    3
    4
    5
    32% >5

    32%

    Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy
    and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST – Triple Therapy
    CHADS2 score at baseline for AF patients
    CHADS2 score at baseline for AF patients*

    7% 2% 12% 1
    2
    15% 3
    4
    27% 5
    >5

    37%

    Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy
    and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Acute Coronary Syndrome in groups
    Acute coronary syndrome at baseline
    31%

    30%

    29%

    28%

    27%

    26%

    25%

    24%

    23%

    22%
    Series1

    Double Triple

    Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy
    and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Primary Endpoints (Bleeding in 1y)

    Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Primary Endpoints (Bleeding in 1y)

    64%
    RRR

    Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Secondary Endpoints (Composite Efficacy)

    Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Secondary Endpoints (Composite Efficacy)

    40%
    RRR

    Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and
    undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.
    WOEST –
    Study Limitations
    Published Paper 1 Other Sources 2
    • No Placebo Group.
    • Not blinded.
    • Underpowered to detect differences in stent thrombotic events(2ry Endpoints).

    Major bleeding episodes are likely to This study did not compare novel OACs
    come to the attention
    of investigators.
    Aspirin seems to have been stopped Bleeding differences were mainly driven
    after bleeding events. by minor bleeding
    No data available about “INR” control. The low use of PPIs may have increased
    bleeding rates

    1- Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant
    therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-
    15. doi: 10.1016/S0140-6736(12)62177-1.
    2 - https://www.wikijournalclub.org/wiki/WOEST
    WOEST – PPI use
    PPI was UNDERPRESCRIPED!
    PPI use

    34% PPI
    No-PPI
    66%

    Adapted from: Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy
    and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013 Mar 30;381(9872):1107-15. doi:
    10.1016/S0140-6736(12)62177-1.

    You might also like