Shorter Clot-Prevention Therapy After Stent Placement Shows Equal Effectiveness with Reduced Bleeding Risk in AFib Patients

Patients with atrial fibrillation who receive coronary stents may soon benefit from a shorter, safer medication regimen according to new research presented at the American Heart Association's Scientific Sessions 2025. The study found that a one-month course of dual clot-preventing therapy followed by single medication therapy for the remaining 11 months was equally effective at preventing stroke, heart attack and death compared to the standard year-long dual therapy approach, while significantly reducing bleeding complications.

The OPTIMA-AF trial, led by Dr. Yohei Sotomi of the University of Osaka Graduate School of Medicine, involved 1,101 adults with an average age of 75.2 years who had atrial fibrillation and underwent drug-eluting stent implantation. After stent placement, half of the participants received both a direct oral anticoagulant and a P2Y12 inhibitor for one month, followed by only the anticoagulant for the remaining 11 months. The other half continued the dual therapy for the full 12 months.

Results showed that 5.4% of participants in the one-month group and 4.5% in the 12-month group experienced heart attack, stroke or death, indicating comparable effectiveness between the two approaches. More significantly, the one-month dual-treatment group had substantially fewer bleeding complications at 4.8% compared to 9.5% in the 12-month group. Most of this reduction came from fewer serious bleeds requiring medical attention, which can impact quality of life and increase healthcare costs.

This research addresses a critical clinical challenge, as up to one in ten people who receive stents also have atrial fibrillation, a disorder that increases stroke risk five-fold and can lead to blood clots, heart failure and death. According to American Heart Association statistics available at https://www.heart.org, an estimated five million U.S. adults have AFib, with projections suggesting more than 12 million Americans will be affected by 2030.

The study represents the first evidence that shortening dual therapy duration to just one month maintains protection against cardiovascular events while reducing bleeding risk. Previous research had established that using two anti-clotting agents instead of three reduced bleeding, but no study had tested whether the duration could be safely shortened to one month. Patients and healthcare providers can find additional information about atrial fibrillation and coronary stents through the American Heart Association's educational resources at https://www.heart.org/en/health-topics/atrial-fibrillation.

While these findings are promising, the study has several limitations. Conducted exclusively in Japan, the results may not directly apply to other populations. Additionally, participants mostly had stable heart disease, so outcomes may differ for higher-risk patients. The study population was only 20% women, limiting generalizability to female patients. The research remains preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at American Heart Association scientific meetings are not peer-reviewed.

The potential impact of these findings is substantial for the estimated millions of AFib patients worldwide who require stent procedures. By reducing the length of combination therapy exposure, clinicians may be able to lower bleeding risk—a serious concern particularly for older adults—without compromising protection against stroke or heart attack. This simplified approach could transform post-stent care for AFib patients, improving safety profiles while maintaining therapeutic effectiveness.