Increased cardiovascular death with single antiplatelet therapy in oral anticoagulation-treated chronic coronary artery disease: meta-analysis of randomized trials

INTRODUCTION: The optimal antithrombotic regimen for chronic coronary artery disease (CAD) requiring long‑term anticoagulation remains uncertain. OBJECTIVES: We aimed to determine the effects of oral anticoagulation (OAC) monotherapy in comparison with OAC plus single antiplatelet therapy (OAC+SAPT) on cardiovascular mortality in chronic CAD. The secondary objective was to assess the effects of both antithrombotic approaches on major bleeding, nonfatal ischemic events, and all‑cause death. PATIENTS AND METHODS: We searched PubMed, Embase, and Cochrane CENTRAL (up to August 2025) for randomized trials comparing OAC alone vs OAC+SAPT in chronic CAD. Fixed‑effects models were used when heterogeneity was low (I²