Single vs. dual antithrombotic therapy in patients with oral anticoagulation and stabilized coronary artery disease: a systematic review and meta-analysis of randomized-controlled trials

AimsDespite consistent recommendations from clinical guidelines, data from randomized trials on a long-term antithrombotic treatment strategy for patients with oral anticoagulation (OAC) and stabilized coronary artery disease (CAD) are still limited and underpowered for ischaemic events. Therefore, we investigated the safety and efficacy of single vs. dual antithrombotic therapy (SAT vs. DAT) in patients with OAC and stabilized CAD.MethodsA systematic review and meta-analysis was performed using PubMed to search for randomized clinical trials comparing SAT vs. DAT in patients with OAC and stabilized CAD.ResultsFive trials encompassing 5758 patients (SAT=2897 vs. DAT=2861) were included. The predominant indication of OAC was atrial fibrillation (n=5495, 95.4%). Most of the patients had prior percutaneous coronary intervention (PCI) (81.1%). The primary safety outcome (trial-defined major bleeding) was lower with SAT compared with DAT [hazard ratio 0.58, 95% confidence interval (95% CI) 0.40-0.83; P<0.001; I2=65.9%] as was the composite of major bleeding or clinically relevant nonmajor (CRNM) bleeding (hazard ratio 0.62, 95% CI 0.400.96; P=0.03; I2=54.6%). There were no differences between the groups in terms of all-cause death, myocardial infarction, stroke, and the trial-defined composite of major adverse cardiovascular events. These findings were consistent among sensitivity analyses.ConclusionIn OAC patients with stabilized CAD, largely due to atrial fibrillation and prior (6-12months) PCI, SAT is associated with lower major bleeding without increased risk of ischaemic complications compared with DAT.