Key result
OAC monotherapy reduces major bleeding and likely lowers mortality compared to DATT in CCS.
Why the study?
Oral anticoagulation monotherapy is recommended for patients with chronic coronary syndrome requiring long-term anticoagulation, and recent trials suggested a mortality benefit not demonstrated previously, prompting this analysis to quantify the probabilities of benefit.
Does oral anticoagulation monotherapy reduce all-cause death and major bleeding compared with dual antithrombotic therapy in patients with chronic coronary syndrome requiring long-term anticoagulation?
Meta-Analysis (n=5,924)
Randomized controlled trials included
Does oral anticoagulation monotherapy reduce all-cause death and major bleeding compared with dual antithrombotic therapy in patients with chronic coronary syndrome requiring long-term anticoagulation?
In chronic coronary syndrome patients requiring long-term anticoagulation, oral anticoagulation monotherapy significantly reduces major bleeding and shows a high probability of mortality benefit compared with dual antithrombotic therapy without increasing ischemic risk.
OAC monotherapy may be preferred in anticoagulated CCS patients; extends RCT meta-analysis by quantifying high probability of mortality superiority.
Background Oral anticoagulation (OAC) monotherapy is recommended for patients with chronic coronary syndrome (CCS) requiring long-term anticoagulation. Recent trials suggest a mortality benefit not demonstrated previously. We conducted a Bayesian meta-analysis to quantify probabilities of benefit. Methods PubMed, Embase, and CENTRAL were searched to January 2026 for randomised controlled trials comparing OAC monotherapy with dual antithrombotic therapy (DATT) in CCS patients requiring long-term anticoagulation. Bayesian random-effects models used weakly informative priors for treatment effects and outcome-specific heterogeneity priors; robustness was assessed with sensitivity analyses using non-informative priors. Primary outcomes were all-cause death and major bleeding. Secondary outcomes were major adverse cardiovascular events (MACE), myocardial infarction (MI), ischaemic stroke, all stroke, major or clinically relevant non major bleeding, and net adverse clinical events (NACE). Results are reported as risk ratios (RR) with 95% credible intervals (CrI) and probabilities of superiority. Results Six trials (5924 participants) were included. OAC monotherapy was associated with likely reduced all-cause death (RR 0.77, 95% CrI 0.58–1.07; 94.6% probability of superiority) and significantly reduced major bleeding (RR 0.51, 95% CrI 0.36–0.69; 100%). Cardiovascular death favoured OAC monotherapy (RR 0.73; 95% CrI 0.53 - 1.06; 95.4%), as did major or clinically relevant non major bleeding (RR 0.50; 95% CrI 0.37–0.65; 100%) and net adverse clinical events (RR 0.64; 95% CrI 0.49–0.82; 99.8%). There was inconclusive evidence for MACE (RR 0.88, 95% CrI 0.68–1.14; 86.0%), MI (RR 1.03, CrI 0.62–1.70; 45.9%), ischaemic stroke (RR 1.07, 95% CrI 0.71–1.68; 36.8%), and all stroke (RR 1.12; 95% CrI 0.68–1.86; 33.1%). Between-study heterogeneity was low to moderate; findings were robust in sensitivity analyses.CRD420260533373 Conclusions In CCS patients requiring long-term anticoagulation, OAC monotherapy significantly reduces bleeding and demonstrates high probability of mortality benefit compared with DATT, without increased ischaemic risk, supporting its use as the preferred antithrombotic strategy. Registration: PROSPERO CRD420260533373mainplotabstract.jpegfig2abstract.jpeg
No takes yet. Share an insight, caveat, or question.
Rodriguez-Tapia et al. (2026) conducted a meta-analysis in Chronic coronary syndrome requiring long-term anticoagulation (n=5,924). Oral anticoagulation (OAC) monotherapy vs. Dual antithrombotic therapy (DATT) was evaluated on All-cause death and major bleeding (RR 0.77 (all-cause death); RR 0.51 (major bleeding), 95% CI 0.58-1.07 (all-cause death); 0.36-0.69 (major bleeding)). OAC monotherapy versus DATT in CCS reduced major bleeding (RR 0.51, 95% CrI 0.36-0.69) and likely reduced all-cause death (RR 0.77, 95% CrI 0.58-1.07; 94.6% probability of superiority).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: