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.

Authors

Sang-Hyup Lee, Soo-Jin Kim, Ae-Young Her, Byung-Ryul Cho, Gwang-Sil Kim, Taek-Geun Kwon, Sang-Wook Lim, Jaemin Shim, Ji-Yong Jang, Yong-Joon Lee, Seung-Jun Lee, Hee Tae Yu, Sung-Jin Hong, Chul-Min Ahn, Byeong-Keuk Kim, Young-Guk Ko, Donghoon Choi, Myeong-Ki Hong, Yangsoo Jang, Hui-Nam Pak, Jung-Sun Kim, Jung Ho Heo

Published in

Age and ageing. Volume 55. Issue 8. Aug 03, 2026.

Abstract

Evidence for non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy for older patients with atrial fibrillation (AF) and drug-eluting stents is lacking.
We aimed to evaluate the safety and efficacy of NOAC monotherapy in older AF patients with drug-eluting stents.
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.
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.
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.

PMID:
42546025
Bibliographic data and abstract were imported from PubMed on 04 Aug 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.