Antithrombotic strategy according to age in patients with atrial fibrillation and drug-eluting stents: a post hoc analysis of the ADAPT AF-DES randomised trial
In brief
NOAC alone cuts net adverse events to 10% versus 22% in AF patients 75 years and
In a post-hoc analysis of 960 AF patients with drug-eluting stents, those aged at least 75 years receiving NOAC monotherapy experienced a net adverse clinical event rate of 9.8% compared with 22.3% on NOAC + clopidogrel, a roughly 60% relative reduction. The benefit was not seen in younger patients, and bleeding rates were similarly lower across ages, suggesting age-guided antithrombotic tailoring may be worthwhile.
- Journal
- Age and ageing (Q1)
- Published
- 3 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Sang-Hyup Lee, Soo-Jin Kim, Ae-Young Her, Byung-Ryul Cho, Gwang-Sil Kim, Taek-Geun Kwon, et al.
- PMID
- 42546025
- DOI
- 10.1093/ageing/afag224
Why clinicians should know about it
- Picked for Cardiology and Cardiovascular Medicine (top studies of the week, 1 November 2026): NOAC monotherapy vs combo in AF with DES
Abstract
BACKGROUND: Evidence for non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy for older patients with atrial fibrillation (AF) and drug-eluting stents is lacking. OBJECTIVES: We aimed to evaluate the safety and efficacy of NOAC monotherapy in older AF patients with drug-eluting stents. METHODS: This is a secondary analysis of the ADAPT AF-DES randomised trial comparing NOAC monotherapy with combination therapy with NOAC plus clopidogrel in patients with AF and drug-eluting stents. Patients were stratified by age (≥75 years and <75 years). Apixaban or rivaroxaban was used as the NOAC. The primary endpoint was a net adverse clinical event at 1 year after randomisation, defined as a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism or major or clinically relevant non-major bleeding defined by the International Society on Thrombosis and Haemostasis criteria. RESULTS: Among 960 patients included in the ADAPT AF-DES trial, 376 (39.2%) patients were aged ≥75 years. In patients aged ≥75 years, the incidence of the primary endpoint was lower in the NOAC monotherapy group (9.8% vs. 22.3%; adjusted hazard ratio, 0.37; 95% confidence interval, 0.21-0.66; P < .001) than in the combination therapy group. In contrast, the incidences did not differ between treatment strategies in patients aged <75 years. The interaction between age groups and strategy groups did not reach statistical significance (P for interaction = .095). The reduction in major or clinically relevant non-major bleeding with NOAC monotherapy was consistent across age groups. In contrast, the benefit of NOAC monotherapy in major adverse cardiac and cerebrovascular events was more pronounced in patients aged ≥75 years, with a statistically significant interaction. CONCLUSIONS: In this post hoc analysis, NOAC monotherapy was associated with a lower risk of net adverse clinical events, specifically within the older age subgroup. Tailored approach regarding age and individual ischaemic risk may be needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.