Arrhythmias & electrophysiology
Anticoagulation and Antiplatelet Therapy for Atrial Fibrillation and Stable Coronary Disease: Meta-Analysis of Randomized Trials
Pooled result · Composite of MI, ischemic stroke, systemic embolism or deathResult — go to the resultHazard ratio 0.90 95% CI 0.72–1.12Authors' conclusion
In patients with AF and stable CAD, OAC monotherapy, compared with OAC plus SAPT, was not associated with a statistically significant increased risk of ischemic events but resulted in a significantly reduced risk of bleeding.
Study context
- Population
- Patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) (mean age 73.9 years, 20.1% women)
- Participants
- 4,092 patients · 4 randomized controlled trials (RCTs)
- Comparison
- Oral anticoagulation (OAC) monotherapy vs OAC plus single antiplatelet therapy (SAPT)
- Outcome
- Composite of:
- MI
- Ischemic stroke
- Systemic embolism or death (primary effectiveness)
- Major bleeding (primary safety)
Methodological detailsprespecified subgroup analyses, unpublished data from principal investigators, Median follow-up 12 to 30 months (weighted mean 21.9 months), Searched PubMed, Embase and ClinicalTrials.gov until September 09, 2024
- Prespecified subgroup analyses
- Unpublished data from principal investigators
- Median follow-up 12 to 30 months (weighted mean 21.9 months)
- Searched PubMed, Embase and ClinicalTrials.gov until September 09, 2024
Pooled result
As reported in the abstract
Composite of:
- MI
- Ischemic stroke
- Systemic embolism
- Death
Hazard ratio
0.90
95% CI 0.72–1.12
By group
OAC monotherapy vs OAC plus SAPT
HR 0.90 (95% CI 0.72–1.12)
Further pooled results
| Outcome | OAC monotherapy | OAC plus SAPT | HR (95% CI) | |
|---|---|---|---|---|
| MI | 1.0% | 0.7% | 1.51 (0.75–3.04) | |
| Ischemic stroke | 1.9% | 2.1% | 0.89 (0.57–1.37) | |
| All-cause death | 4.2% | 5.3% | 0.94 (0.49–1.80) | |
| CV death | 2.4% | 3.0% | 0.79 (0.54–1.15) | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | OAC monotherapy | OAC plus SAPT | HR (95% CI) | |
|---|---|---|---|---|
| Major bleeding (primary safety outcome) · no significant interactions for effectiveness | 3.3% | 5.7% | 0.59 (0.44–0.79) | |
| 0.512Hazard ratio (log scale) |
- Major bleeding (primary safety outcome) — Bleeding reduction possibly greater in men
- Pinteraction = 0.03
- Major bleeding (primary safety outcome) — Bleeding reduction possibly greater in patients with DM
- Pinteraction = 0.04
Original publication
Anticoagulation and Antiplatelet Therapy for Atrial Fibrillation and Stable Coronary Disease: Meta-Analysis of Randomized Trials. J Am Coll Cardiol. Published 17 January 2025. doi:10.
Summarised from the published abstract; every number is checked against it