Afib and coronary artery disease: OAC monotherapy vs OAC + single antiplatelet therapy

  • Lee SR & al.
  • Am J Cardiol
  • 25 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Oral anticoagulant (OAC) monotherapy and OAC plus single antiplatelet therapy (SAPT) showed similar efficacy in patients with non-valvular atrial fibrillation (Afib) and coronary artery disease (CAD).
  • However, the risk for bleeding was significantly reduced with OAC monotherapy compared with OAC plus SAPT.

Why this matters

  • Although guidelines recommend OAC monotherapy for patients with Afib and stable CAD of >1 year after myocardial infarction or percutaneous coronary intervention, there is limited evidence on their use.

Study design

  • 6 studies (n=8855) that compared OAC monotherapy with OAC plus single SAPT for patients with stable CAD and non-valvular AF were identified.
  • Primary outcome: major adverse cardiovascular events (MACEs; ischaemic or thrombotic events).
  • Secondary outcomes: major bleeding, stroke, all-cause death and adverse events (ischaemic, thrombotic or bleeding events).
  • Funding: None.

Key results

  • No significant difference was observed in MACEs between OAC and OAC plus SAPT groups (HR, 1.09; 95% CI, 0.92-1.29; P=.309).
  • Compared with OAC monotherapy, OAC plus SAPT group had a significantly higher risk for:
    • major bleeding (HR, 1.61; 95% CI, 1.38-1.87; P<.001 and>
    • adverse event (HR, 1.21; 95% CI, 1.02-1.43; P=.026).
  • All-cause death (HR, 1.07; 95% CI, 0.91-1.27; P=.411) and stroke (HR, 0.99; 95% CI, 0.70-1.40; P=.950) rates did not differ in OAC monotherapy vs OAC plus SAPT treatment.

Limitations

  • Treatment quality of vitamin K antagonist not evaluated in all studies.