Direct oral anticoagulant monotherapy vs combination therapy with antiplatelets in chronic coronary syndrome patients with prior percutaneous coronary intervention requiring anticoagulation: A meta-analysis

It remains uncertain if direct oral anticoagulant monotherapy improves outcomes beyond bleeding risk compared with combination therapy with antiplatelets in chronic coronary syndrome patients with prior percutaneous coronary intervention requiring anticoagulation. In this meta-analysis of randomized trials, direct oral anticoagulant monotherapy significantly reduced major adverse cardiac and cerebrovascular events and major bleeding without increasing ischemic events. The benefit in major adverse cardiac and cerebrovascular events was driven primarily by reductions in all-cause and cardiovascular mortality, supporting a bleeding-avoidance strategy in this high-risk population. Trial registration PROSPERO (CRD420251231341). © 2026 Elsevier Inc.