What is the Optimal Antithrombotic Strategy in Patients With Atrial Fibrillation Undergoing PCI?

Launched by ST. ANTONIUS HOSPITAL · Jun 16, 2020

Keywords

ClinConnect Summary

The WOEST 3 trial is studying the best way to prevent blood clots in patients with atrial fibrillation (AF) who are undergoing a procedure called percutaneous coronary intervention (PCI), often used to treat blocked arteries. Typically, patients with AF take medications to prevent strokes, but after PCI, they may need additional medications to prevent complications like heart attacks or stent blockages. This trial is exploring whether a short course of dual antithrombotic therapy (DAPT) — which includes two types of blood-thinning medications — is safer and just as effective as the standard approach, which involves a combination of three medications (triple antithrombotic therapy or TAT). Researchers believe that using DAPT for a month may reduce the risk of bleeding while still protecting against serious heart problems.

To be eligible for this trial, participants must be at least 18 years old, have recently undergone a successful PCI, and have a history of atrial fibrillation that requires long-term treatment with blood thinners. Participants will be closely monitored for any bleeding issues and heart-related problems over a six-week period after the procedure. This trial is important because it may help determine a safer treatment strategy for patients with both AF and coronary artery disease.

Gender

ALL

Eligibility criteria

• Inclusion Criteria:
• • 1. Patients ≥ 18 years
• • 2. Undergoing successful PCI (either ACS or elective PCI)
• • 3. History of or newly diagnosed (\<72 hours after PCI/ACS) atrial fibrillation or flutter with a long-term (≥ 1 year) indication for OAC
• Exclusion Criteria:
• • 1. Contra indication to edoxaban, aspirin or all P2Y12 inhibitors
• • 2. Current indication for OAC besides atrial fibrillation/flutter (e.g. venous thromboembolism)
• • 3. \<12 months after any stroke
• • 4. CHADSVASc score ≥7
• • 5. Moderate to severe mitral valve stenosis (AVA ≤1.5 cm2)
• • 6. Mechanical heart valve prosthesis
• • 7. Intracardiac thrombus or apical aneurysm requiring OAC
• • 8. Poor LV function (LVEF \<30%) with proven slow-flow
• • 9. History of intracranial haemorrhage
• • 10. Active bleeding on randomization
• • 11. History of intraocular, spinal, retroperitoneal, or traumatic intra-articular bleeding, unless the causative factor has been permanently resolved
• • 12. Recent (\<1 month) gastrointestinal haemorrhage, unless the causative factor has been permanently resolved.
• • 13. Known coagulopathy
• • 14. Severe anaemia requiring blood transfusion or thrombocytopenia \<50 × 109/L
• • 15. BMI \>40 or bariatric surgery
• • 16. Kidney failure (eGFR \<15)
• • 17. Active liver disease (ALT, ASP, AP \>3x ULN or active hepatitis A, B or C)
• • 18. Active malignancy excluding non-melanoma skin cancer
• • 19. Life expectancy \<1 year
• • 20. Pregnancy or breast-feeding women