Anticoagulation Alone May Be Better for Patients With CAD

Oral anticoagulation alone linked to lower risks for cardiovascular death and bleeding than adding an antiplatelet

Mar. 16, 2026 at 9:35am

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In a meta-analysis of six randomized trials involving 5,924 patients with stable coronary artery disease (CAD), oral anticoagulation alone was associated with a 31% lower risk of cardiovascular death and a 54% lower risk of major bleeding compared to the combination of oral anticoagulation plus a single antiplatelet agent. Oral anticoagulation alone was also linked to a 39% lower risk of net adverse clinical events.

Why it matters

These findings challenge the common practice of adding an antiplatelet medication to oral anticoagulation in patients with stable CAD, as the combination therapy did not provide additional benefits but increased the risk of major bleeding events.

The details

Researchers conducted an updated meta-analysis to compare long-term outcomes of oral anticoagulation alone versus oral anticoagulation plus single antiplatelet therapy in patients with stabilized CAD. The analysis included six randomized trials, with 98.4% of patients having atrial fibrillation as the indication for oral anticoagulation. Patients were randomly assigned to receive either anticoagulation alone (50.1%) or the combination regimen (49.9%). Oral anticoagulation monotherapy was implemented beyond 6-12 months after the first qualifying coronary event, with mean follow-up durations ranging from 12 to 30 months.

  • The study was published online on March 4, 2026.

The players

Giuseppe Gargiulo

MD, PhD, from the University of Naples Federico II in Naples, Italy, and co-lead author of the study.

Raffaele Piccolo

MD, PhD, from the University of Naples Federico II in Naples, Italy, and co-lead author of the study.

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What they’re saying

“Our results do not support a relatively liberal recommendation of OAC [ oral anticoagulation] + SAPT [single antiplatelet therapy] in patients at high ischemic risk because no such evidence exists. A class III with evidence of harm for OAC + SAPT after 6 to 12 months in OAC patients after ACS/PCI [acute coronary syndrome/percutaneous coronary intervention] might more closely mirror the available evidence.”

— Giuseppe Gargiulo and Raffaele Piccolo, Study authors

What’s next

The researchers noted that their findings do not support a liberal recommendation of using oral anticoagulation plus a single antiplatelet therapy in patients at high ischemic risk, as the evidence does not show any benefits for this combination approach.

The takeaway

This meta-analysis suggests that for patients with stable coronary artery disease, oral anticoagulation alone may be the preferred treatment strategy, as it is associated with lower risks of cardiovascular death and major bleeding compared to the combination of oral anticoagulation and a single antiplatelet agent.