Claudio Laudani: Balancing Ischemic and Bleeding Risk in AF with Coronary Disease
Claudio Laudani, Cardiologist at Autonomo, Former Postdoctoral Researcher at UF Health Jacksonville, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in JACC Journals, adding:
“Atrial fibrillation (AF) is the most common arrhythmia worldwide and frequently coexists with coronary artery disease (CAD), creating one of the most challenging scenarios in antithrombotic management.
While AF requires long-term oral anticoagulation to prevent stroke, CAD often leads to prolonged antiplatelet therapy after coronary interventions, increasing bleeding risk when both conditions overlap.
In our new meta-analysis, led by Mattia Galli, we evaluated the optimal long-term antithrombotic strategy in patients with AF and concomitant CAD requiring oral anticoagulation.
Pooling data from 6 randomized trials including 5,294 patients, we found that oral anticoagulation (OAC) alone was superior to the combination of OAC plus single antiplatelet therapy (SAPT) for long-term management.
Compared with combination therapy, OAC alone did not increase the risk of ischemic events.
Instead, it:
- Reduced any bleeding by 51 percent
- Reduced major bleeding by 54 percent
- Reduced cardiovascular death by 31 percent
- Reduced net adverse clinical events (NACE) by 40 percent
Notably, the number needed to treat to prevent one cardiovascular death was only 91 patients.
In analyses restricted to patients receiving DOACs, OAC monotherapy was also associated with lower all-cause mortality.
Overall, our findings support OAC alone as the preferred long-term antithrombotic regimen in patients with AF and stable CAD, while combination therapy should likely be limited to the early post-PCI period, when thrombotic risk is highest.
Our full paper is now available in JACC: Cardiovascular Interventions.”
Title: Oral Anticoagulation With or Without Antiplatelet Therapy in Chronic Coronary Syndrome: A Meta-Analysis of Randomized Trials
Authors: Mattia Galli, Mattia Vinciguerra, Claudio Laudani, Giovanni Occhipinti, Domenico D’Amario, Antonio Iaconelli, Francesco Franchi, Ernesto Greco, Giacomo Frati, Sebastiano Sciarretta, Davide Capodanno, Diana A. Gorog, Renato D. Lopes, C. Michael Gibson, Roxana Mehran, Dominick J. Angiolillo
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