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Why the study?
Evidence supporting the discontinuation of antiplatelet therapy in patients with stable coronary artery disease who require anticoagulation remains limited and continues to evolve.
Does oral anticoagulant monotherapy reduce major bleeding and prevent MACE compared to oral anticoagulant plus single antiplatelet therapy in patients with stable coronary artery disease beyond six months after coronary revascularization requiring anticoagulation?
Meta-Analysis (n=5,924)
Does oral anticoagulant monotherapy reduce major bleeding and prevent MACE compared to oral anticoagulant plus single antiplatelet therapy in patients with stable coronary artery disease beyond six months after coronary revascularization requiring anticoagulation?
Hazard Ratio: 0.8 (95% CI 0.62–1.04)
In patients with stable coronary artery disease requiring anticoagulation beyond six months post-revascularization, oral anticoagulant monotherapy significantly reduces major bleeding without increasing the risk of major adverse cardiovascular events compared to combined therapy.
Anticoagulant monotherapy yields comparable MACE risk in stable CAD; reinforces monotherapy as sufficient without added antiplatelet benefit.
BACKGROUND Evidence supporting the discontinuation of antiplatelet therapy in patients with stable coronary artery disease who require anticoagulation remains limited and continues to evolve. This study aimed to assess the efficacy and safety of antithrombotic therapy in this population. METHODS We reviewed randomized controlled trials comparing the efficacy and safety of oral anticoagulant monotherapy versus oral anticoagulant plus single antiplatelet therapy in patients beyond six months after coronary revascularization requiring anticoagulation. The outcomes included major adverse cardiovascular events (MACE) and major bleeding. MACE was defined as a composite of all-cause death, myocardial infarction, stroke, systemic embolism, and revascularization. A pairwise meta-analysis using a random-effects model was conducted. RESULTS A total of 5924 patients from 6 randomized controlled trials were included: 2970 received oral anticoagulant alone, and 2954 received oral anticoagulant plus single antiplatelet therapy. Anticoagulant monotherapy was associated with a comparable risk of MACE [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.62-1.04] and a significantly lower major bleeding risk (HR, 0.46; 95% CI, 0.32-0.66) than the combined therapy. CONCLUSION Oral anticoagulant alone may be a reasonable strategy to mitigate bleeding risk while preserving an ischemic risk comparable to combined anticoagulant and antiplatelet therapy.
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Hiruma et al. (2026) conducted a meta-analysis in stable coronary artery disease requiring anticoagulation (n=5,924). Oral anticoagulant monotherapy vs. Oral anticoagulant plus single antiplatelet therapy was evaluated on major adverse cardiovascular events (MACE) (HR 0.80, 95% CI 0.62-1.04).
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