Key result
Oral anticoagulant monotherapy was associated with a lower incidence of major bleeding events compared to combination therapy with antiplatelets, without increasing the risk of cardiovascular death, stroke, or myocardial infarction.
Why the study?
It remained uncertain whether patients with atrial fibrillation and stable coronary artery disease requiring long-term oral anticoagulation should also receive antiplatelet treatment.
Does oral anticoagulation monotherapy reduce major bleeding without increasing ischemic events compared to combined oral anticoagulation and antiplatelet therapy in patients with stable coronary artery disease and atrial fibrillation?
Meta-Analysis (n=9,199)
Does oral anticoagulation monotherapy reduce major bleeding without increasing ischemic events compared to combined oral anticoagulation and antiplatelet therapy in patients with stable coronary artery disease and atrial fibrillation?
In patients with stable CAD and AF, OAC monotherapy reduces major bleeding risk without increasing the risk of ischemic events or mortality compared to OAC plus antiplatelet therapy.
Answers are grounded in this paper and cite their sources.
OAC monotherapy may reduce major bleeding without excess ischemic risk in AF with stable CAD; extends prior evidence but warrants confirmation in dedicated RCTs.
It is still uncertain whether patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) who require long-term oral anticoagulation (OAC) should also receive antiplatelet treatment (APT). This meta-analysis aims to compare the efficacy and safety of OAC alone with OAC plus APT in individuals with AF and stable CAD. The current meta-analysis was conducted as per the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Meta-analysis of Observational Studies in Epidemiology (MOOSE). We performed electronic searches using PubMed, EMBASE, and Cochrane Library. The efficacy outcomes assessed in this meta-analysis included cardiovascular death, myocardial infarction, stroke (ischemic and hemorrhagic), and all-cause mortality. The safety outcome included major bleeding events. A total of five studies were included in the current meta-analysis enrolling 9199 patients with stable CAD and AF. Out of these five studies, three were observational and two were randomized controlled trials (RCTs). Our study showed no significant difference between two groups in the incidence of cardiovascular mortality (Hazard ratio {HR}: 0.86, 95% confidence interval {CI}: 0.59-1.25, I-square: 44%), myocardial infarction (HR: 1.21, 95% CI: 0.73-2.01, I-square: 0%), all-cause mortality (HR: 0.95, 95% CI: 0.76-1.19, I-square: 68%) and stroke (HR: 0.83, 95% CI: 0.61-1.12, I-square: 45%). However, lower incidence of major bleeding events in patients who received OAC alone as compared to patients who received a combination of OAC and anti-platelet (HR: 1.37, 95% CI: 1.18-1.580, I-square: 78%) were found. The current meta-analysis showed that OAC monotherapy is associated with a lower incidence of major bleeding events in patients with stable CAD and AF. It is also not associated with an increased risk of all-cause mortality, cardiovascular death, stroke, and myocardial infarction.
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Tentu et al. (2022) conducted a meta-analysis in Stable Coronary Artery Disease and Atrial Fibrillation (n=9,199). Oral anticoagulant (OAC) monotherapy vs. Oral anticoagulant plus single antiplatelet therapy (SAPT) was evaluated on Major bleeding events (HR 1.37, 95% CI 1.18-1.580). Oral anticoagulant monotherapy was associated with a lower incidence of major bleeding events compared to combination therapy with antiplatelets, without increasing the risk of cardiovascular death, stroke, or myocardial infarction.
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