Shorter Clot-Prevention Therapy After Stent Placement Proves Effective for AFib Patients
New research shows a one-month course of dual clot-preventing therapy followed by single medication treatment is as effective as year-long dual therapy for preventing stroke, heart attack and death in atrial fibrillation patients with stents, while significantly reducing bleeding complications.
New research presented at the American Heart Association's Scientific Sessions 2025 suggests that a simplified medication regimen for clot prevention following stent placement in adults with atrial fibrillation may offer similar protection against serious cardiovascular events with fewer bleeding complications. The study found that using two clot-preventing medications for just one month instead of the standard twelve months was equally effective at preventing stroke, heart attack and death.
The OPTIMA-AF trial included 1,101 adults with an average age of 75.2 years who had atrial fibrillation and underwent drug-eluting stent implantation. All participants received treatment at 75 hospitals in Japan between October 2019 and September 2024. Half of the study participants received dual antithrombotic therapy for one month followed by a direct oral anticoagulant alone for the remaining eleven months, while the other half continued dual therapy for the full twelve months.
According to study author Yohei Sotomi, M.D., Ph.D., director of the Osaka Cardiovascular Conference Multicenter Clinical Research Lab, standard treatment after stent implantation involves prescribing two clot-preventing medications for one year, but these medications can increase the risk of serious bleeding. The medications included direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban and edoxaban to prevent strokes, and P2Y12 inhibitors such as clopidogrel or prasugrel to prevent clots in the stent.
After one year of follow-up, researchers found that 5.4% of participants in the one-month group and 4.5% in the twelve-month group experienced heart attack, stroke or death, indicating comparable effectiveness between the two approaches. More significantly, participants in the one-month dual-treatment group experienced notably fewer bleeding complications: 4.8% versus 9.5% in the twelve-month group. Most of the bleeding reduction came from less serious bleeds that required medical attention, which can affect quality of life and increase healthcare costs.
"Previous studies confirmed that using two anti-clotting agents instead of three reduced bleeding, however, no study has tested whether the duration of dual therapy could be safely shortened to just one month," Sotomi said. "Our study is the first to show that a one-month strategy is both safe and effective, offering real-world benefits for patients and doctors."
The findings are particularly relevant given that up to one in ten people who receive a stent also have atrial fibrillation, a disorder that increases stroke risk by five-fold and can lead to blood clots, heart failure and death. According to American Heart Association 2025 Heart and Stroke statistics, an estimated five million adults in the U.S. have atrial fibrillation, with projections suggesting more than 12 million people will be affected by 2030. Additional information about atrial fibrillation and heart health can be found at https://www.heart.org/en/health-topics/atrial-fibrillation.
While the study represents an important advancement in cardiovascular care, researchers noted several limitations. The study was conducted exclusively in Japan, so findings may not directly apply to populations in other countries. Additionally, most participants had stable heart disease, so results may not apply to patients with higher risk for blood clots. The study population also included only about 20% women, limiting generalizability to female patients.
The American Heart Association provides comprehensive guidelines for atrial fibrillation management, including the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation available at https://www.ahajournals.org/doi/10.1161/CIR.0000000000001193. The association also offers patient support resources through programs like MyAFibExperience® to help individuals manage their condition.
As Sotomi concluded, "These results may help doctors feel more confident in prescribing shorter durations of dual antithrombotic therapy after stenting among some patients with AFib. By reducing the length of time individuals are exposed to combination therapy, we can lower the risk of bleeding - a serious concern for many older adults - without increasing their risk of stroke or heart attack."