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

초록

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. © The Author(s) 2026. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/pages/standard-publication-reuse-rights)

키워드