Key result
OAC monotherapy cuts major bleeding ~45% vs dual therapy in AF and CAD, with similar ischemic events.
Why the study?
Data comparing the clinical outcomes of OAC monotherapy versus dual antithrombotic therapy in patients with AF and stable CAD were limited.
Does oral anticoagulant monotherapy reduce major bleeding compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
Meta-Analysis (n=3,945)
Does oral anticoagulant monotherapy reduce major bleeding compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
Effect estimate: RR 0.55 (95% CI 0.32-0.95)
In patients with atrial fibrillation and stable coronary artery disease, OAC monotherapy reduces major bleeding without increasing ischemic events or mortality compared to dual antithrombotic therapy.
Supports OAC monotherapy to minimize bleeding in AF with stable CAD; confirms ischemic safety and strengthens guideline recommendations.
BACKGROUND: Oral anticoagulants (OACs) are routinely used for the management of atrial fibrillation (AF) while antiplatelet agents are used in coronary artery disease (CAD). However, data regarding the comparative clinical outcomes of OAC monotherapy versus dual antithrombotic therapy (anticoagulant plus antiplatelet agent) in patients with AF and stable CAD are limited. METHODS: A comprehensive search of major databases including PubMed/MEDLINE, Cochrane Library, and Embase was performed from inception to September 1, 2024 to identify randomized control trials (RCTs) that compared OAC monotherapy with dual antithrombotic therapy in patients with AF and stable CAD. The risk ratios (RRs) were estimated with corresponding 95% confidence intervals (CIs) for all outcomes. RESULTS: A total of three RCTs reported data for 3945 patients with AF and stable CAD. The mean age of patients was 73.8 (±11.85) years and the mean follow-up was 22 months. OAC monotherapy was associated with a significantly reduced relative risk of major bleeding (RR: 0.55, 95% CI: 0.32-0.95) compared to dual therapy. The risk of all-cause death (RR: 0.85, 95% CI: 0.49-1.48), cardiovascular death (RR: 0.84, 95% CI: 0.50-1.41), any stroke event (RR: 0.74, 95% CI: 0.46-1.18), and myocardial infarction (RR: 1.57, 95% CI: 0.79-3.12) remained comparable across the two groups. CONCLUSION: OAC monotherapy led to a significant relative risk reduction for major bleeding with similar rates of ischemic events and mortality compared to dual antithrombotic therapy in patients with AF and stable CAD.
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Ahmed et al. (2024) conducted a meta-analysis in Atrial fibrillation and stable coronary artery disease (n=3,945). Oral anticoagulant (OAC) monotherapy vs. Dual antithrombotic therapy (anticoagulant plus antiplatelet agent) was evaluated on Major bleeding (RR 0.55, 95% CI 0.32-0.95). OAC monotherapy significantly reduced the risk of major bleeding (RR 0.55; 95% CI 0.32-0.95) compared to dual antithrombotic therapy in patients with AF and stable CAD, with similar ischemic events.
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