Coronary disease & ACSMeta-analysis
Oral anticoagulant monotherapy vs. combination therapy in patients with chronic coronary syndrome: a systematic review and meta-analysis of randomized trials
- Systematic review and meta-analysis of randomised trials
- Bayesian random-effects models
Authors' conclusion
In CCS patients on OAC, OAC monotherapy reduces bleeding events compared to combination therapy, without clear evidence of a concomitant increase in ischemic risk.
Study context
- Population
- Patients with chronic coronary syndrome and any indication for long-term oral anticoagulation (OAC)5 of 6 RCTs pooled
- Participants
- 5,777 patients
- Comparison
- OAC monotherapy vs OAC plus single antiplatelet therapy
- Outcome
- Net adverse clinical events (NACE)
Pooled result
NACE
Hazard ratio
0.61
95% CrI 0.43–0.85
OAC monotherapy vs Combination therapy
HR 0.61 (95% CrI 0.43–0.85)
As reported in the abstract
Further pooled results
| Outcome | HR (95% CrI) | |
|---|---|---|
| Major bleeding · CrI | 0.47 (0.30–0.71) | |
| Major or clinically relevant non-major bleeding · CrI | 0.47 (0.31–0.66) | |
| 0.20.5125Hazard ratio (log scale) |
- Major bleeding: Bayesian random-effects; 95% CrI
- Major or clinically relevant non-major bleeding: Bayesian random-effects; 95% CrI
Major adverse cardiovascular events (MACE)
- No significant difference in MACE (HR, 95% CrI)
- HR 0.83, 95% CrI 0.60-1.18
CV death
- No significant difference in CV death (HR, 95% CrI)
- HR 0.70, 95% CrI 0.44-1.13
All-cause death, unplanned revascularisation, MI, ischaemic stroke
- No significant differences
MACE, DOAC vs VKA monotherapy (prespecified subgroup)
- Signal of lower MACE risk with DOAC monotherapy vs VKA monotherapy
- P = 0.02
Safety
| Outcome | HR (95% CrI) | |
|---|---|---|
| Major bleeding · CrI | 0.47 (0.30–0.71) | |
| Major or clinically relevant non-major bleeding · CrI | 0.47 (0.31–0.66) | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
Oral anticoagulant monotherapy vs. combination therapy in patients with chronic coronary syndrome: a systematic review and meta-analysis of randomized trials. Eur J Prev Cardiol. Published 11 August 2026. doi:10.1093/eurjpc/zwag416
Summarised from the published abstract; every number is checked against it