Antiplatelet Therapy for Patients With Stable Coronary Artery Disease Receiving Oral Anticoagulation: A Meta-Analysis of Randomized Controlled Trials Publisher Pubmed



Hiruma Y ; Watanabe A ; Aikawa T ; Iwagami M ; Hosseini K ; Slipczuk L ; Briasoulis A ; Takagi H ; Kuno T
Source: Journal of Cardiology Published:2026

Abstract

Background Evidence supporting the discontinuation of antiplatelet therapy in patients with stable coronary artery disease who require anticoagulation remains limited and continues to evolve. This study aimed to assess the efficacy and safety of antithrombotic therapy in this population. Methods We reviewed randomized controlled trials comparing the efficacy and safety of oral anticoagulant monotherapy versus oral anticoagulant plus single antiplatelet therapy in patients beyond six months after coronary revascularization requiring anticoagulation. The outcomes included major adverse cardiovascular events (MACE) and major bleeding. MACE was defined as a composite of all-cause death, myocardial infarction, stroke, systemic embolism, and revascularization. A pairwise meta-analysis using a random-effects model was conducted. Results A total of 5924 patients from 6 randomized controlled trials were included: 2970 received oral anticoagulant alone, and 2954 received oral anticoagulant plus single antiplatelet therapy. Anticoagulant monotherapy was associated with a comparable risk of MACE [hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.62–1.04] and a significantly lower major bleeding risk (HR, 0.46; 95% CI, 0.32–0.66) than the combined therapy. Conclusion Oral anticoagulant alone may be a reasonable strategy to mitigate bleeding risk while preserving an ischemic risk comparable to combined anticoagulant and antiplatelet therapy. © 2026 Elsevier Ltd.