Key result
Single OAC cuts major bleeding ~41% vs. dual therapy in AF and stable CAD.
Why the study?
Guideline recommendations for oral anticoagulation monotherapy were based on prematurely terminated trials underpowered for bleeding and mortality, but new randomized data have become available.
Does single-agent oral anticoagulation therapy reduce major bleeding and all-cause death compared with dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
Meta-Analysis (n=4,092)
Does single-agent oral anticoagulation therapy reduce major bleeding and all-cause death compared with dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
This meta-analysis confirms that in patients with atrial fibrillation and stable coronary artery disease, oral anticoagulant monotherapy reduces major bleeding by 41% compared with dual antithrombotic therapy without increasing mortality or ischemic events.
Answers are grounded in this paper and cite their sources.
Supports single-agent oral anticoagulation to reduce major bleeding without mortality increase in AF with stable CAD; reinforces current guidelines from prior RCTs.
BACKGROUND: In patients with atrial fibrillation and stable coronary artery disease, guidelines recommend oral anticoagulation monotherapy after periods on dual antithrombotic therapy. These recommendations are based on evidence from prematurely terminated randomized controlled trials that were underpowered for bleeding and mortality end points. New data are available, so we conducted a systematic review and meta-analysis to pool the totality of randomized evidence. METHODS: This investigation was preregistered on International Prospective Register of Systematic Reviews (CRD42024590457). Systematic searches and data extraction were performed independently and in duplicate for randomized controlled trials enrolling patients with atrial fibrillation and stable coronary artery disease that reported clinical end points. The prespecified coprimary end points were major bleeding and all-cause death. Prespecified secondary outcomes included all bleeding, cardiovascular death, noncardiovascular death, myocardial infarction, stroke, the composite of net adverse cardiovascular events and coronary revascularization. End point data were pooled using fixed and random effect models, to generate hazard ratios (HR) and relative risks and corresponding 95% CIs. RESULTS: =72%), or other secondary outcomes. CONCLUSIONS: In patients with stable coronary artery disease and atrial fibrillation, oral anticoagulation monotherapy reduces major bleeding compared with dual antithrombotic therapy. There were no significant differences in all-cause and cardiovascular death, myocardial infarction, stroke, adverse cardiovascular events, and coronary revascularization.
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Reddy et al. (2025) conducted a meta-analysis in Atrial fibrillation and stable coronary artery disease (n=4,092). Single-agent oral anticoagulation therapy (SAT) vs. Dual antithrombotic therapy (DAT: oral anticoagulation plus an antiplatelet agent) was evaluated on Coprimary endpoint: Major bleeding (ISTH criteria) and all-cause death (HR 0.59, 95% CI 0.44-0.79, p=<0.001). Single-agent oral anticoagulation reduced major bleeding by 41% (HR 0.59, 95% CI 0.44-0.79, P<0.001) without affecting all-cause death compared with dual antithrombotic therapy in AF and stable CAD.
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