Less is more: Safe and effective without unnecessary combinations

Recent studies show that combining oral anticoagulation (e.g., DOAC) with low-dose aspirin or clopidogrel in patients with atrial fibrillation and chronic coronary artery disease may cause more harm than good.

• The AQUATIC study had to be terminated early because the combination of anticoagulation plus low-dose aspirin led to 53% more major adverse cardiovascular events (MACE) and more than three times as many serious bleeds compared to anticoagulation alone.
• Similarly, the ADAPT AF-DES study showed that anticoagulation alone (without clopidogrel) resulted in 46% fewer serious cardiovascular events and 62% fewer serious bleeding events.
• Further studies such as AFIRE and EPIC CAD confirm these findings and challenge the long-standing practice of routinely treating patients with atrial fibrillation and coronary artery disease with a combination of anticoagulants and antiplatelet drugs.

In practice, this means that for many patients, oral anticoagulation with DOACs alone is sufficient and additional antiplatelet therapy is often unnecessary and even risky.