Single antiplatelet therapy vs oral anticoagulation monotherapy in patients with atrial fibrillation and coronary artery disease after successful catheter ablation: A target trial emulation.

BACKGROUND

The optimal long-term antithrombotic strategy in patients with atrial fibrillation (AF) and coronary artery disease (CAD) after successful catheter ablation (CA) remains uncertain.

OBJECTIVE

This study aimed to compare the effectiveness and safety of single antiplatelet therapy (SAPT) vs oral anticoagulation (OAC) monotherapy in this population.

METHODS

This cohort study used a target trial emulation framework based on data from the China Atrial Fibrillation Registry. Patients with nonvalvular AF and CAD who underwent index CA were screened. Those free from AF recurrence, thromboembolism, or bleeding 12 months after ablation were included and categorized according to antithrombotic regimen at the 12-month landmark. The primary effectiveness outcome was thromboembolism (ischemic stroke or systemic embolism), and the primary safety outcome was bleeding (International Society on Thrombosis and Haemostasis major or clinically relevant nonmajor bleeding). Secondary outcomes included all-cause mortality and net clinical benefit. Inverse probability of treatment weighting was used for confounding adjustment.

RESULTS

Among 998 patients (mean age 66.8 years; 26.5% women), 706 received SAPT and 292 OAC monotherapy. Over a mean follow-up of 3.0 years, 19 thromboembolic and 29 bleeding events occurred. After weighting, no statistically significant difference in thromboembolism was observed (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.18-1.61), whereas SAPT was associated with lower bleeding risk (HR, 0.40; 95% CI, 0.18-0.91). No significant differences were observed in mortality (HR, 0.77; 95% CI, 0.35-1.72) or net clinical benefit (HR, 0.66; 95% CI, 0.36-1.20).

CONCLUSION

In this stable postablation population with AF and CAD, SAPT was associated with lower bleeding risk vs OAC monotherapy, whereas no statistically significant difference in thromboembolism was observed.