Anticoagulation and Antiplatelet Therapy Versus Anticoagulation Alone in Patients With Chronic Coronary Syndrome Receiving Long-Term Anticoagulation: A Meta-Analysis of Randomized Clinical Trials

Q: What are the key findings of this study?

The Anticoagulation Management Services annual review exposure significantly resulted in a lower end-of-study concurrent antiplatelet use of 7% compared to 16% in usual care among patients on long-term DOACs.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Long-term direct oral anticoagulant (DOAC) use (n=8459). Intervention: Anticoagulation Management Services (AMS) annual review vs. Usual care (non-AMS group). Primary outcome: End-of-study antiplatelet use (p=<0.0001).

Gilles Lemesle; Romain J. Didier; Abdourahmane Diallo; Hubert Dromas; Christophe Bauters; Philippe Gabríel Steg; Tabassome Simon; Nicolas Danchin; Sandro Ninni; Gilles Montalescot; Éric Vicaut; Martine Gilard; Guillaume Cayla

doi:10.1161/circulationaha.125.077141

November 8, 2025Circulation

Anticoagulation and Antiplatelet Therapy Versus Anticoagulation Alone in Patients With Chronic Coronary Syndrome Receiving Long-Term Anticoagulation: A Meta-Analysis of Randomized Clinical Trials

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Key result

Anticoagulation management service annual review is linked to ~9 percentage points less concurrent antiplatelet use.

P<0.0001
n=8,459

Why the study?

Does a structured Anticoagulation Management Service annual review reduce concurrent antiplatelet use and increase PPI use in patients receiving long-term DOACs compared to usual care?

Study Design

Type

Observational (n=8,459)

Multicenter

No

Structured PICO

Does a structured Anticoagulation Management Service annual review reduce concurrent antiplatelet use and increase PPI use in patients receiving long-term DOACs compared to usual care?

P

Population

8,459 adults receiving long-term direct oral anticoagulants were evaluated in a retrospective chart review to assess the impact of an organized anticoagulation management service on antithrombotic therapy over a one-year period.

E

Exposure

Management under an Anticoagulation Management Service (AMS) utilizing collaborative drug therapy management and nursing protocols, specifically an annual review process to optimize antithrombotic therapy (deprescribing antiplatelets and adding PPIs for gastroprotection).

C

Comparator

Usual care group (non-AMS group) of patients taking DOACs managed by their prescribing team without enrollment in the AMS.

O

Outcome

Rates of background antiplatelet use and rates of proton pump inhibitor (PPI) use for gastric prophylaxis in patients on dual antithrombotic therapy at the end of the 1-year study period.

Main Result

Absolute Event Rate: 7% vs 16%

p-value: p=<0.0001

Implementation of an annual antithrombotic therapy review within an Anticoagulation Management Service significantly improved adherence to prescribing guidelines by reducing potentially inappropriate antiplatelet use and increasing protective PPI use in patients receiving long-term DOACs.

Limitations

Medication use data for the non-AMS group were collected solely based on electronic medical records and were not confirmed through patient interviews, potentially underreporting over-the-counter aspirin use.
Only evaluated the impact of the annual review initiative when it was first launched in 2023, excluding patients enrolled subsequently.
Did not perform multivariable adjustment for baseline patient characteristics that may have influenced bleeding or thrombotic risk.
Patients were not followed longitudinally for clinical outcomes such as ischemic or bleeding events.
Conducted among a cohort of patients from a single ambulatory care organization, limiting generalizability.
The study only evaluated the impact of the annual review initiative when it was first launched in 2023.

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Implication

May support anticoagulation service reviews to reduce concurrent antiplatelet use in DOAC patients; leaves open confirmation of outcome benefits in randomized trials.

Abstract

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Discussion

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Cite This Study

Lemesle et al. (2025) conducted an observational in Long-term direct oral anticoagulant (DOAC) use (n=8,459). Anticoagulation Management Services (AMS) annual review vs. Usual care (non-AMS group) was evaluated on End-of-study antiplatelet use (p=<0.0001). The Anticoagulation Management Services annual review exposure significantly resulted in a lower end-of-study concurrent antiplatelet use of 7% compared to 16% in usual care among patients on long-term DOACs.

synapsesocial.com/papers/6ad2b54b4c9c4fbb13a7ee4b https://doi.org/10.1161/circulationaha.125.077141

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Anticoagulation and Antiplatelet Therapy Versus Anticoagulation Alone in Patients With Chronic Coronary Syndrome Receiving Long-Term Anticoagulation: A Meta-Analysis of Randomized Clinical Trials

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Anticoagulation and Antiplatelet Therapy Versus Anticoagulation Alone in Patients With Chronic Coronary Syndrome Receiving Long-Term Anticoagulation: A Meta-Analysis of Randomized Clinical Trials

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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