Oral anticoagulant monotherapy in patients with chronic coronary disease: An updated meta-analysis.

Background: The optimal antithrombotic strategy for patients with chronic coronary disease requiring long-term anticoagulation remains uncertain. While dual therapy with oral anticoagulants (OACs) and antiplatelet agents is common, it significantly increases bleeding risk. This meta-analysis was conducted to compare the efficacy and safety of OAC monotherapy against combination therapy.

Methods: We searched PubMed, Embase, ClinicalTrials.gov, and Cochrane library through August 2025 to identify randomized controlled trials (RCTs) comparing OAC monotherapy to dual therapy (OAC plus a single antiplatelet agent) in patients with chronic coronary disease. The primary outcome was a composite of cardiovascular death, stroke, myocardial infarction, and major bleeding.

Results: Five RCTs with 4964 participants were included. OAC monotherapy was associated with a significantly lower risk of the primary composite outcome (RR: 0.68, 95% CI: 0.53-0.85). The risks of all-cause death, cardiovascular death, myocardial infarction, stroke, and systemic embolism were comparable between the two groups. OAC monotherapy significantly reduced the risk of major bleeding (RR: 0.49, 95% CI: 0.31-0.77) and major or clinically relevant non-major bleeding (RR: 0.51, 95% CI: 0.38-0.68).

Conclusions: In patients with chronic coronary disease requiring long-term anticoagulation, OAC monotherapy reduces bleeding complications without increasing the risk of ischemic events compared to dual therapy. These findings support the use of a simplified antithrombotic strategy without antiplatelet therapy in this patient population.