ADAPT AF-DES: NOAC Monotherapy Is Superior to Combination Therapy in Patients With Atrial Fibrillation After Drug-Eluting Stent Implantation

The ADAPT AF-DES trial evaluated the optimal antithrombotic strategy after 12 months of drug-eluting stent implantation in patients with atrial fibrillation. 

The ADAPT AF-DES was an open-label, multicenter, randomized, non-inferiority clinical trial conducted in South Korea that enrolled 960 patients with atrial fibrillation (AF) who had undergone drug-eluting stent (DES) implantation at least 12 months earlier. Participants were assigned to receive either NOAC monotherapy (apixaban or rivaroxaban) or combination therapy with NOAC plus clopidogrel, and were followed for 12 months. The primary endpoint was a composite of all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism, or major or clinically relevant non-major bleeding. 

After one year, net adverse clinical events occurred in 9.6% of patients on monotherapy compared with 17.2% on combination therapy (HR 0.54; 95.2% CI 0.37–0.77; p<0.001 for superiority). The benefit was primarily driven by a marked reduction in major and clinically relevant bleeding (5.2% vs. 13.2%; HR 0.38; 95% CI 0.24–0.60), without any increase in ischemic events such as myocardial infarction, stroke, or stent thrombosis. These findings consolidate the efficacy and safety of NOAC monotherapy in stable AF patients with second- or third-generation stents beyond the first year after PCI. 

In clinical practice, the ADAPT AF-DES trial reinforces both European and American guideline recommendations, demonstrating that NOAC monotherapy is not only non-inferior but superior to combination therapy in balancing efficacy and safety. These results simplify long-term antithrombotic management in AF patients with stable coronary disease and can significantly reduce bleeding risk without compromising ischemic protection. 

Editorial note: This content was developed with the support of artificial intelligence technologies for optimization of writing and information structure. All material was carefully reviewed, validated, and complemented by human experts before publication, ensuring scientific accuracy and adherence to editorial best practices. 

Referências:  

1. Lee S-J et al. Therapy for Atrial Fibrillation in Patients with Drug-Eluting Stents (ADAPT AF-DES). N Engl J Med. 2025; DOI: 10.1056/NEJMoa2512091.