Anticoagulant alone lowers bleeding without harm
In chronic coronary disease needing long-term anticoagulation, anticoagulant-only treatment reduced bleeding without increasing heart attack, stroke, or death versus adding one antiplatelet drug.
*Systematic review and meta-analysis of randomized trials; Level 1a (OCEBM).

Citation

Ahmed M, Rana JS, Ahmed R, Fonarow GC. Oral anticoagulant monotherapy in patients with chronic coronary disease: An updated meta-analysis. The American Journal of Medicine. 2026;139:232–237. doi:10.1016/j.amjmed.2025.09.019.

Background

Many patients with stable, long-term coronary artery disease also need long-term blood-thinner treatment for other reasons (often atrial fibrillation). Adding an antiplatelet drug is common but can increase bleeding, so whether a single blood-thinner alone is safer without raising clot-related events is important.

Patients

Adults with chronic coronary disease requiring long-term oral anticoagulation (most had atrial fibrillation; many had prior coronary stenting).

Intervention

Oral anticoagulant alone.

Control

Oral anticoagulant plus one antiplatelet drug (aspirin or a clopidogrel-like agent).

Outcome

Primary composite: cardiovascular death, stroke, heart attack, and major bleeding; plus bleeding outcomes and clot-related outcomes.

Follow-up Period

Median 24.1 months (5 trials; 4,964 participants).

Results

Outcome Effect (anticoagulant alone vs combination)
Primary composite outcome (primary) Risk ratio 0.68 (95% confidence interval 0.53–0.85)
Major bleeding Risk ratio 0.49 (95% confidence interval 0.31–0.77)
Major or clinically important non-major bleeding Risk ratio 0.50 (95% confidence interval 0.37–0.68)
All-cause death, cardiovascular death, heart attack, stroke, and systemic embolism: NS.

Limitations

Bleeding results varied across trials; most participants were from Asian populations; event rates were low for some clot-related outcomes; drug types and doses differed.

Funding

No external funding; one author reported industry consulting outside this work.

Clinical Application

For stable chronic coronary disease needing long-term anticoagulation, consider stopping routine single antiplatelet therapy after the early stent period to reduce bleeding risk.