Oral anticoagulation monotherapy is the preferred long-term antithrombotic strategy over combination therapy in patients with stable chronic coronary syndrome, as it reduces major bleeding without increasing ischemic events.
Does oral anticoagulation monotherapy improve net clinical benefit compared to combination therapy in patients with atrial fibrillation and stable chronic coronary syndrome?
Current evidence supports OAC monotherapy as the preferred long-term antithrombotic strategy in patients with AF and stable CCS, as it reduces bleeding and mortality without increasing ischemic risk.
Abstract Purpose of Review Atrial fibrillation (AF) and/or the need for oral anticoagulation (OAC) frequently coexist with stable chronic coronary syndrome (CCS). In this population, clinicians must carefully balance ischemic protection against bleeding risk. This review aims to synthesize available evidence and address whether antiplatelet therapy (APT) should be maintained on top of OAC in this specific subset. Recent Findings Recent trials have provided key evidence. AFIRE, EPIC-CAD, AQUATIC and ADAPT-AF-DES have all demonstrated that OAC monotherapy is not only non-inferior but also superior to combination therapy (OAC plus APT) in terms of net clinical benefit, with fewer major bleeding events and no increase in ischemic complications. The AQUATIC and AFIRE trials even showed an excess in mortality with prolonged combination therapy. Summary Current evidence supports OAC alone as the preferred long-term antithrombotic strategy in patients with AF and stable CCS.
Dromas et al. (Sat,) conducted a review in Chronic coronary syndrome requiring oral anticoagulation (n=5,924). Oral anticoagulation (OAC) monotherapy vs. Combination therapy (OAC plus single antiplatelet therapy) was evaluated. Oral anticoagulation monotherapy is the preferred long-term antithrombotic strategy over combination therapy in patients with stable chronic coronary syndrome, as it reduces major bleeding without increasing ischemic events.