ACP Journal Club. Adding aspirin to clopidogrel worsened outcomes in PCI patients receiving oral anticoagulants.

Commentary The optimal management of patients who need long-term oral anticoagulation and coronary stenting is unknown. Bleeding risks are substantial with triple oral anticoagulation therapy using an oral anticoagulant plus aspirin and clopidogrel for antiplatelet therapy. The WOEST trial showed a reduction in the primary endpoint of any bleeding in patients who received double therapy (oral anticoagulant plus clopidogrel) compared with patients who received triple therapy. The secondary composite endpoint of death, myocardial infarction, stroke, target-vessel revascularization, or stent thrombosis was also reduced in the double-therapy group, primarily driven by a reduction in all-cause death; the trial did not find an increased risk for stent thrombosis.