Oral Anticoagulation Monotherapy vs Dual-Pathway Antithrombotic Therapy in Chronic Coronary Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BackgroundThis study aimed to systematically review randomized controlled trials (RCTs) comparing oral anticoagulant (OAC) monotherapy with combination therapy of OAC plus single antiplatelet therapy (SAPT) in patients with chronic coronary syndrome (CCS) and an indication for long-term anticoagulation.MethodsA systematic screening of the PubMed, EMBASE and Cochrane Central databases was conducted until 12 Mar 2026 to identify RCTs comparing OAC monotherapy with OAC plus SAPT in CCS patients. The primary endpoints were all-cause mortality and net adverse clinical events (NACE). Secondary endpoints included major bleeding, cardiovascular death, myocardial infarction, ischemic stroke and stroke. End point data were pooled using random-effect models, to generate hazard ratios (HR) and odds ratios (OR) and corresponding 95% confidence intervals (CI).ResultsSix RCTs involving 5048 patients were included. Pooled analysis showed that OAC monotherapy significantly reduced the risk of NACE compared to combination therapy (HR, 0.66; 95% CI, 0.44-0.77). There was no significant difference in all-cause mortality overall (HR, 0.75; 95% CI, 0.51-1.10). OAC monotherapy substantially decreased major bleeding (HR, 0.47; 95% CI, 0.32-0.70) and cardiovascular death (HR, 0.69; 95% CI 0.50-0.95) and there was no statistically significant difference in other secondary outcomes.ConclusionsCurrent evidence suggests that OAC monotherapy is a safer alternative to combination therapy in anticoagulated patients with CCS, without increasing ischemic risk.