Arrhythmias & electrophysiologyMeta-analysis
Anticoagulation and Antiplatelet Therapy for Atrial Fibrillation and Stable Coronary Disease
- Systematic review and meta-analysis of randomised trials
- 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- unpublished data from principal investigators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
Authors' 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)
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. J Am Coll Cardiol. Published 17 January 2025. doi:10.1016/j.jacc.2024.12.030
Summarised from the published abstract; every number is checked against it