Arrhythmias & electrophysiology
Single antiplatelet therapy vs oral anticoagulation monotherapy in patients with atrial fibrillation and coronary artery disease after successful catheter ablation: A target trial emulation
Main finding · Primary effectiveness outcome: thromboembolism (ischemic stroke or systemic embolism)Result — go to the resultHazard ratio 0.54 95% CI 0.18–1.61Authors' conclusion
In this stable postablation population with AF and CAD, SAPT was associated with lower bleeding risk vs OAC monotherapy, whereas no statistically significant difference in thromboembolism was observed.
Study context
- Population
- Patients with nonvalvular atrial fibrillation (AF) and coronary artery disease (CAD) who underwent index catheter ablation (CA) and were free from AF recurrence, thromboembolism, or bleeding 12 months after ablationmean age 66.8 years, 26.5% women
- Participants
- 998 patients
- Exposure
- single antiplatelet therapy vs oral anticoagulation monotherapy
- SAPTn = 706
- Oral anticoagulation (OAC) monotherapyn = 292reference
- Outcome
- Primary effectiveness outcome: thromboembolism:
- Ischemic stroke
- Systemic embolism
- Follow-up
- Mean 3.0 years
Methodological detailsbased on data from the China Atrial Fibrillation Registry, 12-month landmark, Inverse probability of treatment weighting
- Based on data from the China Atrial Fibrillation Registry
- 12-month landmark
- Inverse probability of treatment weighting
Main finding
As reported in the abstract
Primary effectiveness outcome: thromboembolism:
- Ischemic stroke
- Systemic embolism
Hazard ratio
0.54
95% CI 0.18–1.61
SAPT vs OAC monotherapy
HR 0.54 (95% CI 0.18–1.61)
- Thromboembolic events
- 19
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortality (secondary) · No significant difference | 0.77 (0.35–1.72) | |
| Net clinical benefit (secondary) · No significant difference | 0.66 (0.36–1.20) | |
| 0.20.5125Hazard ratio (log scale) |
Safety
| Outcome | HR (95% CI) | |
|---|---|---|
| Primary safety outcome: bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding) · mean follow-up of 3.0 years · lower bleeding risk with SAPT · After weighting | 0.40 (0.18–0.91) | |
| 0.20.5125Hazard ratio (log scale) |
- Primary safety outcome: bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding) — bleeding events
- 29
Original publication
Single antiplatelet therapy vs oral anticoagulation monotherapy in patients with atrial fibrillation and coronary artery disease after successful catheter ablation: A target trial emulation. Heart Rhythm. Published 25 May 2026. doi:10.
Summarised from the published abstract; every number is checked against it