11. Antithrombotic therapies

NOAC monotherapy vs NOAC plus clopidogrel for atrial fibrillation in DES patients

ADAPT AF-DES
Objective
to determine whether non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy is noninferior to NOAC plus clopidogrel for net adverse clinical events in patients with atrial fibrillation at least one year after second- or third-generation drug-eluting stent implantation
Study
multicentre, open-label, randomised, noninferiority trial
Population
patients with atrial fibrillation (CHADS-VASc 2) who had undergone the implantation of a drug-eluting stent at least one year earlier
Endpoints
net adverse clinical events, a composite of death from any cause, myocardial infarction, stent thrombosis, stroke, systemic embolism, major bleeding or clinically relevant nonmajor bleeding at 12 months
Conclusion
NOAC monotherapy was noninferior and superior for net adverse clinical events when compared to NOAC plus clopidogrel in patients with atrial fibrillation who had a drug-eluting stent implanted at least one year prior.
Lee et al. N Engl J Med. 2025 Nov 8.
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