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.
SH, L., SJ, K., AY, H., BR, C., GS, K., TG, K., SW, L., J, S., JY, J., & YJ, L. (2026). 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.. Age and ageing. https://doi.org/10.1093/ageing/afag224
SH L, SJ K, AY H, BR C, GS K, TG K, et al. 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.. Age and ageing. 2026; doi: 10.1093/ageing/afag224
SH L, SJ K, AY H, et al. 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.[J]. Age and ageing. 2026. DOI: 10.1093/ageing/afag224.
@article{sh2026,
author = {Lee SH and Kim SJ and Her AY and Cho BR and Kim GS and Kwon TG and Lim SW and Shim J and Jang JY and Lee YJ},
title = {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.},
journal = {Age and ageing},
year = {2026},
doi = {10.1093/ageing/afag224},
note = {PMID: 42546025},
}
TY - JOUR AU - Lee SH AU - Kim SJ AU - Her AY AU - Cho BR AU - Kim GS AU - Kwon TG AU - Lim SW AU - Shim J AU - Jang JY AU - Lee YJ TI - 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. T2 - Age and ageing PY - 2026 DO - 10.1093/ageing/afag224 AN - PMID:42546025 ER -
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.