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WOEST substudy: Uninterrupted oral anticoagulation did not increase bleeding, MACCE
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Uninterrupted oral anticoagulation was not associated with an increase in bleeding or MACCE at 30 days or 1 year compared with bridging therapy among patients who underwent PCI, according to findings from the WOEST trial.
Researchers of the study, which was published recently in EuroIntervention, aimed to determine which periprocedural antithrombotic strategy was most effective in a cohort of 573 patients receiving long-term oral anticoagulation therapy with PCI. Periprocedural treatment decisions were left to the operator’s discretion in the randomized controlled trial.
The two strategies that underwent analysis for feasibility and safety outcomes were bridging therapy — in which patients had their oral anticoagulation (OAC) discontinued prior to PCI — and uninterrupted OAC. Patients administered the bridging therapy who were considered to be at increased risk for thromboembolism received either unfractionated or low molecular weight heparin.
Bleeding complications and MACCE served as the primary outcome measures. The study included 241 patients in the uninterrupted therapy group and 322 in the bridging therapy group.
No significant differences between the two groups were reported with regard to bleeding at 30 days (HR=0.83; 95% CI, 0.50-1.37). This result persisted through 1 year (HR=1.01; 95% CI, 0.71-1.44).
MACCE was slightly less frequent in the uninterrupted therapy group compared with the bridging therapy group at 30 days (HR=0.48; 95% CI, 0.15-1.51) and 1 year (HR=0.72; 95% CI, 0.46-1.14), although these differences did not reach statistical significance.
The researchers added that there were no significant differences when the results were adjusted with a propensity score.
“Performing PCI with [an uninterrupted OAC] strategy was not associated with an increase in the number of bleeding events or MACCE in this study. Furthermore, bleeding or MACCE were not related to INR levels,” the researchers wrote. “This is the largest study up to now to support the recommendations of the 2010 consensus of the European Society of Cardiology Working Group on Thrombosis to adopt a periprocedural strategy of continuing OAC in a therapeutic window during PCI in patients with long-term OAC indication.”
Disclosure: The researchers report no relevant financial disclosures.
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