Home Forums Other Specialities Cardiothoracic Medicine & Surgery CLOPIDOGREL IN PATIENTS ON ANTICOAGULANTS &PCI.

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      Anonymous
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      The Lancet, Volume 381, Issue 9872, Pages 1107 – 1115, 30 March 2013.

      ]Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial
      Original Text.

      Dr Willem JM Dewilde MD a , Tom Oirbans MSc b, Prof Freek WA Verheugt MD c, Johannes C Kelder MD b, Bart JGL De Smet MD d, Jean-Paul Herrman MD c, Tom Adriaenssens MD e, Mathias Vrolix MD f, Antonius ACM Heestermans MD g, Marije M Vis MD h, Prof Jan GP Tijsen MD h, Arnoud W van ‘t Hof MD i, Jurriën M ten Berg MD b, for the WOEST study investigators

      Summary
      Background
      If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin.

      Methods
      We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00769938.

      Findings
      573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26—0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17—0·84, p=0·011).

      Interpretation
      Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events.

      G.MOHAN

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