We read the report by Zinn and Feit with great interest. We learned from the article by Zinn and Feit to individualize care and tailor therapy according to the risk for bleeding but also to ischemic and embolic complications. Zinn and Feit state that all data were retrospective and that most came from single-center series. A randomized trial with head-to-head assessment of differing antithrombotic regimens is needed. Zinn and Feit state that there are no randomized trials prospectively addressing a comparison of triple therapy and dual-antiplatelet therapy to guide clinical decision making. In patients with indication for long-term oral anticoagulation (OAC) who need to undergo percutaneous coronary intervention, there are theoretically 4 possibilities: the combinations of aspirin plus clopidogrel and OAC plus aspirin are unsafe because of elevated risk for stroke and stent thrombosis, respectively. The combination of triple therapy, which is currently recommended, is known for elevated risk for bleeding complications. A last possibility is the combination of OAC and clopidogrel, which seems to be promising. Therefore, on December 1, 2008, the first prospective, randomized, international, multicenter, open-label trial was started and will assess the hypothesis that after percutaneous coronary intervention with stent implantation in patients on OAC therapy, the combination of OAC therapy and clopidogrel 75 mg/day is safe and not inferior to triple therapy with respect to the prevention of thrombotic complications while reducing the risk for bleeding. The primary outcome is the combination of Thrombolysis In Myocardial Infarction (TIMI) and Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) minor, moderate, and major bleeding up to 30 days and 1 year. The secondary outcome is major adverse cardiac events and is intended as a safety end point. The sample size is 496. Given that, to date, no prospective randomized study has yet addressed this issue, the What Is the Optimal Antiplatelet and Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary Stenting (WOEST; http://trials.gov:NCT00769938 ) trial will help establish new guidelines for patients with chronic indications for oral anticoagulation who need coronary stenting.