Key result
DOAC monotherapy reduces MACCE and major bleeding vs antiplatelet combination therapy without increasing ischemic events.
Why the study?
It was uncertain whether DOAC monotherapy improves outcomes beyond bleeding risk compared with combination therapy with antiplatelets in chronic coronary syndrome patients with prior PCI requiring anticoagulation.
Does direct oral anticoagulant (DOAC) monotherapy reduce major adverse cardiac and cerebrovascular events (MACCE) and major bleeding compared to combination therapy with antiplatelets in chronic coronary syndrome patients with prior PCI requiring anticoagulation?
Meta-Analysis
Does direct oral anticoagulant (DOAC) monotherapy reduce major adverse cardiac and cerebrovascular events (MACCE) and major bleeding compared to combination therapy with antiplatelets in chronic coronary syndrome patients with prior PCI requiring anticoagulation?
In patients with chronic coronary syndrome and prior PCI requiring anticoagulation, DOAC monotherapy reduces MACCE and major bleeding compared to combination therapy with antiplatelets, supporting a bleeding-avoidance strategy.
Supports DOAC monotherapy over combination in chronic coronary syndrome post-PCI; confirms MACCE and bleeding reductions in meta-analysis of RCTs.
It remains uncertain if direct oral anticoagulant (DOAC) monotherapy improves outcomes beyond bleeding risk compared with combination therapy with antiplatelets in chronic coronary syndrome patients with prior PCI requiring anticoagulation. In this meta-analysis of randomized trials, DOAC monotherapy significantly reduced major adverse cardiac and cerebrovascular events (MACCE) and major bleeding without increasing ischemic events. The benefit in MACCE was driven primarily by reductions in all-cause and cardiovascular mortality, supporting a bleeding-avoidance strategy in this high-risk population.
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Chi et al. (2026) conducted a meta-analysis in Chronic coronary syndrome with prior PCI requiring anticoagulation. Direct oral anticoagulant (DOAC) monotherapy vs. Combination therapy with antiplatelets was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) and major bleeding. DOAC monotherapy significantly reduced major adverse cardiac and cerebrovascular events and major bleeding without increasing ischemic events compared with combination therapy with antiplatelets.
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