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Lookup NU author(s): Raheel Ahmed
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© 2025 The AuthorsBackground: The optimal antithrombotic strategy for patients with chronic coronary disease requiring long-term anticoagulation remains uncertain. While dual therapy with oral anticoagulants (OACs) and antiplatelet agents is common, it significantly increases bleeding risk. This meta-analysis was conducted to compare the efficacy and safety of OAC monotherapy against combination therapy. Methods: We searched PubMed, Embase, ClinicalTrials.gov, and Cochrane library through August 2025 to identify randomized controlled trials (RCTs) comparing OAC monotherapy to dual therapy (OAC plus a single antiplatelet agent) in patients with chronic coronary disease. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, and major bleeding. Results: Five RCTs with 4964 participants were included. OAC monotherapy was associated with a significantly lower risk of the primary composite outcome (RR: 0.68, 95 % CI: 0.53–0.85). The risks of all-cause death, cardiovascular death, myocardial infarction, stroke, and systemic embolism were comparable between the two groups. OAC monotherapy significantly reduced the risk of major bleeding (RR: 0.49, 95 % CI: 0.31–0.77) and major or clinically relevant non-major bleeding (RR: 0.50, 95 % CI: 0.37–0.68). Conclusions: In patients with chronic coronary disease requiring long-term anticoagulation, OAC monotherapy reduces bleeding complications without increasing the risk of ischemic events compared to dual therapy. These findings support the use of a simplified antithrombotic strategy without antiplatelet therapy in this patient population.
Author(s): Ahmed M, Rana JS, Ahmed R, Fonarow GC
Publication type: Article
Publication status: Published
Journal: American Journal of Medicine
Year: 2025
Pages: epub ahead of print
Online publication date: 25/09/2025
Acceptance date: 22/09/2025
Date deposited: 11/11/2025
ISSN (print): 0002-9343
ISSN (electronic): 1555-7162
Publisher: Elsevier Inc.
URL: https://doi.org/10.1016/j.amjmed.2025.09.019
DOI: 10.1016/j.amjmed.2025.09.019
Data Access Statement: All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author
PubMed id: 41015139
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