What is the future of "Triple Therapy" after coronary stenting?

Identifying the optimal regimen for antiplatelet therapy in patients requiring long-term anticoagulation following coronary stenting is an area that has traditionally been understudied. Although all major guidelines recommend (limited) triple therapy  in this situation, these recommendations are either result of expert consensus or are largely based on observational data. The WOEST trial was an open-labelled randomised trial and compared dual therapy (a combination of clopidogrel and vitamin K antagonist) with  triple therapy (Aspirin, clopidogrel and vitamin K antagonist) in patients undergoing coronary stenting.The indication for anticoagulant was atrial fibrillation in approximately 70% of patients. Femoral access site was used in vast majority of patients while drug-eluting stents (DES) were used in 2/3rd  of the cases. The primary end-point was bleeding and unsurprisingly dual therapy  was associated with significantly lower bleeding risk. However, more importantly the combined secondary end point (death, myocardial infarction, stroke, target-vessel revascularization, and stent thrombosis) was also significantly lower in the clopidogrel plus warfarin group. Moving forward from the WOEST data, newer non-vitamin K antagonist OAC (NOAC) are currently being studied in open-labelled randomised trials of NOAC and vitamin K antagonist based dual and triple therapy. Two such trials currently recruiting are PIONEER AF-PCI (Rivaroxaban) and RE-DUAL PCI (Da...
Source: Doc2Doc BMJ Cardiology - Category: Cardiology Authors: Source Type: forums