Recent systemic and meta-analysis study states that the approximately 200 million people globally affects stable coronary artery disease which remains a major cause for morbidity and mortality. Eventhrough after the treatment the patients have the residual risk of major adverse cardiovascular events such as heart attack and stroke.
What is the objective of the study?
The aim of these study was to provide the comprehensive comparison of different antithrombotic strategies in stable CAD by analyzing,
-Monotherapy options.
-Anticoagulant strategies in patients with artial fibrillation
-Intensified therapy in high-risk patients
-Special Populations like diabtes
Findings
1)Clopidogrel vs Aspirin-Monotherapy
Aspirin is replaced by the Clopidogrel which is the single antiplatelet therapy in many stable CAD patients because it showed better efficacy and better safety(lower bleeding risk).
2)Atrial Fibrillation and stable CAD
Oral Anticoagulant and antiplatelet was compared and the result was OAC monotherapy decrease the cardiovascular events and significantly less bleeding.
3)Intensified Antithrombotic Therapy
Dual Antiplatelet therapy, increases the bleeding so this approaches is very narrow it can be used in carefully selected high risk patients.
Summary
Emerging evidence suggest that the clopidogrel has the better efficacy and safety then the aspirin, while oral anticoagulant is preferred in patients with atrial fibrillation and stable CAD.
Finally the future of cardiology depends in the personalized treatment strategies.
https://www.jacc.org/doi/10.1016/j.jacadv.2026.102633
Do you think aspirin should still remain in the first line therapy in all stable CAD patients?
MBH/AB