TOPLINE:

In patients with stable coronary artery disease (CAD), oral anticoagulation alone was linked to lower risks for cardiovascular deaths, major bleeding, and overall adverse events than oral anticoagulation plus a single antiplatelet agent, but it was not linked to higher risks for other poor outcomes, according to a meta-analysis published as a brief report in JACC.

METHODOLOGY:

• Researchers conducted an updated meta-analysis to compare long-term outcomes of oral anticoagulation alone vs oral anticoagulation plus single antiplatelet therapy in patients with stabilized CAD.
• They searched PubMed through November 2025 and included six randomized trials comparing the two regimens in 5924 patients; of these, 98.4% had atrial fibrillation as the indication for oral anticoagulation.
• Patients were randomly assigned to receive either anticoagulation alone (50.1%) or the combination regimen of oral anticoagulation plus single antiplatelet therapy (49.9%).
• Oral anticoagulation monotherapy was implemented beyond 6-12 months after the first qualifying coronary event, with mean follow-up durations ranging from 12 to 30 months.
• The main efficacy outcome was cardiovascular mortality at the longest follow-up, and the main safety outcome was major bleeding. Secondary outcomes included major bleeding or clinically relevant nonmajor bleeding, any bleeding, all-cause death, major adverse cardiovascular events, net adverse clinical events, myocardial infarction, stroke, and stent thrombosis.

TAKEAWAY:

• Patients on oral anticoagulation alone had a 31% lower risk for cardiovascular death than those on the combination regimen (six trials; P = .02; heterogeneity [I²] = 4.95%); the risk for major bleeding was 54% lower with oral anticoagulation alone (five trials; P < .001; I² = 48.5%).
• Oral anticoagulation alone was associated with a 39% lower risk for net adverse clinical events than the combination regimen (five trials; P < .001; I² = 66.4%).
• Oral anticoagulation alone was also associated with a 51% lower risk for combined major and clinically relevant nonmajor bleeding (six trials; P < .001; I² = 40.9%) and a 46% lower risk for any bleeding (six trials; P < .001; I² = 0%).
• Researchers found no statistically significant differences in the risk for major adverse cardiovascular events, myocardial infarction, stroke, stent thrombosis, or all‑cause death between the two groups.

IN PRACTICE:

“Our results do not support a relatively liberal recommendation of OAC [ oral anticoagulation] + SAPT [single antiplatelet therapy] in patients at high ischemic risk because no such evidence exists. A class III with evidence of harm for OAC + SAPT after 6 to 12 months in OAC patients after ACS/PCI [acute coronary syndrome/percutaneous coronary intervention] might more closely mirror the available evidence,” the researchers of the study wrote.

SOURCE:

The study was jointly led by Giuseppe Gargiulo, MD, PhD, and Raffaele Piccolo, MD, PhD, both from the University of Naples Federico II in Naples, Italy. It was published online on March 4 as a brief report in JACC.

LIMITATIONS: 

The authors did not explicitly mention any limitations.

DISCLOSURES:

Several authors reported receiving research funding, grants, consulting fees, honoraria, or other personal payments from pharmaceutical and medical device companies, and a few reported having equity interests or affiliations with endowed departments supported by industry.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.