N Engl J Med

Monotherapy bests combo therapy for afib patients with drug-eluting stents

November 14, 2025

The ADAPT AF-DES randomized trial (NCT04250116) showed that, in patients with afib who’d received a drug-eluting stent (DES) ≥1 year earlier, NOAC monotherapy was not only noninferior but superior to NOAC plus clopidogrel. Among 960 predominantly older (mean age, 71) patients, net adverse clinical events occurred in 9.6% on monotherapy vs. 17.2% on combination therapy (hazard rate [HR], 0.54; P <0.001), driven largely by a significant reduction in major or clinically relevant bleeding events (5.2% vs. 13.2%; HR 0.38). These findings reinforce current guideline recommendations and fill a key evidence gap, simplifying long-term antithrombotic management after DES.

Clinical takeaway: For afib patients with drug-eluting stents, consider NOAC monotherapy rather than combination therapy—this approach lowers bleeding risk without increasing ischemic events.

Source:

Lee SJ, et al; ADAPT AF-DES Investigators. (2025, November 8). N Engl J Med. Therapy for Atrial Fibrillation in Patients with Drug-Eluting Stents. https://pubmed.ncbi.nlm.nih.gov/41211917/