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Giuseppe Andò: Stable CAD + Oral Anticoagulation: Is Combination Therapy Still Justified?

Giuseppe Andò/ResearchGate

Jan 3, 2026, 12:39

Giuseppe Andò: Stable CAD + Oral Anticoagulation: Is Combination Therapy Still Justified?

Giuseppe Andò, Head of the Cardiology Department at Papardo University Hospital, shared on LinkedIn:

” Stable CAD + Oral Anticoagulation: Is Combination Therapy Still Justified?
For years, adding antiplatelet therapy to oral anticoagulation has been considered “safer.”
The evidence no longer supports this approach.

In the post-AQUATIC era, leveraging data from a large European RCT that expanded indications for OAC beyond atrial fibrillation, we conducted an updated meta-analysis of 6 randomized trials (n = 5,924) comparing OAC monotherapy vs OAC + SAPT in stable coronary artery disease.

OAC monotherapy delivers:
−51% major bleeding
Lower net adverse clinical events
Reduced cardiovascular mortality
No increase in ischemic events
Even more compelling: DOAC-based monotherapy significantly reduced MACE, with a clear treatment interaction.

Bottom line:
In patients with stable CAD requiring long-term anticoagulation, less is more.
OAC monotherapy—particularly with DOACs—should be the default strategy, especially in East Asian populations.

After AQUATIC, continuing routine combination therapy deserves serious reconsideration.”

Title: Oral anticoagulation with versus without antiplatelet therapy in patients with stable coronary artery disease and an indication for anticoagulation: a meta-analysis with trial sequential analysis

Authors: Ahmed Ibrahim, Ali Saad Al-Shammari, Shrouk Ramadan, Yousif Hameed Kurmasha, Khadeeja Ali Hamzah, M Rafiqul Islam, Muhammad Younas, Hritvik Jain, Yasar Sattar, Pierre Sabouret and Giuseppe Andò.

Giuseppe Andò: Stable CAD + Oral Anticoagulation: Is Combination Therapy Still Justified?