Coronary disease & ACSMeta-analysis
Antiplatelet Therapy in Stable Coronary Artery Disease
- random-effects meta-analyses, network meta-analysis, and meta-regression
- randomized controlled trials (RCTs) and observational studies
Authors' conclusion
Based on 2 RCTs, clopidogrel monotherapy may offer advantages over aspirin in stable CAD. RCT evidence supports anticoagulant monotherapy in atrial fibrillation with stable CAD beyond 12 months post-revascularization. Intensified strategies may benefit selected high-risk patients though narrow therapeutic margins (number needed to treat 91 vs number needed to harm 85) necessitate careful patient selection.
Study context
- Population
- Patients with stable coronary artery disease (CAD), including atrial fibrillation with stable CAD, high-risk patients and patients with diabetespatients in 23 studies (13 RCTs, 6 observational, 4 post-hoc)
- Participants
- 437,662 patients
- Comparison
- monotherapy comparisons, oral anticoagulant strategies in atrial fibrillation with CAD, intensified therapy in high-risk patients, and diabetes-specific strategies
- Outcome
- major adverse cardiovascular events (MACEs) and major bleeding
Pooled result
As reported in the abstract
Hazard ratio (CI)
clopidogrel vs aspirinMACE; 2 RCTs (HOST-EXAM, CAPRIE; n = 24,623)
0.73(0.59–0.90)
clopidogrel vs aspirinbleeding
0.63(0.41–0.97)
anticoagulant monotherapy vs combination therapyefficacy; atrial fibrillation with stable CAD; 2 RCTs (AFIRE, EPIC-CAD; n = 3,276)
0.61(0.49–0.76)
anticoagulant monotherapy vs combination therapysafety
0.52(0.36–0.76)
intensified therapyMACE; Four RCTs
0.85(0.80–0.91)
intensified therapybleeding; increased
1.85(1.65–2.07)
Original publication
Antiplatelet Therapy in Stable Coronary Artery Disease. JACC Adv. doi:10.1016/j.jacadv.2026.102633
Summarised from the published abstract; every number is checked against it