Stable coronary disease is often associated with an increased risk of arterial fibrillation. Antithrombotic therapy is one of the treatments in patients with arterial fibrillation, but the results are unclear. The objective of this research is to evaluate the efficacy of antithrombotic therapy for arterial fibrillation in patients with stable coronary disease.

This is a multicenter, open-label trial that included a total fo 2,236 patients with arterial fibrillation who had undergone coronary artery bypass grafting (GAFT) or percutaneous coronary intervention (PCI). The participants were divided into two groups and were assigned to either monotherapy with rivaroxaban or combination therapy with rivaroxaban plus a single antiplatelet agent. The primary outcome was a composite of stroke, myocardial infarction, systemic embolism, or unstable angina.

The rivaroxaban monotherapy was non-inferior to the combination therapy for incidence of cardiovascular events. The rivaroxaban monotherapy was superior to the combination therapy in terms of the safety endpoint. The trial was halted early due to increased mortality in the combination therapy group. 

The research concluded that antithrombotic rivaroxaban monotherapy was non-inferior to combination therapy for efficacy and superior to the combination therapy for safety in patients with arterial fibrillation and stable coronary artery disease.

Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa1904143