---
title: "NOAC monotherapy vs NOAC+clopidogrel by age in AF patients with drug-eluting stents"
id: "pubmed-42546025"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42546025"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42546025/"
doi: "10.1093/ageing/afag224"
published_at: "2026-08-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# NOAC monotherapy vs NOAC+clopidogrel by age in AF patients with drug-eluting stents
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42546025
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42546025/)
- **DOI:** [10.1093/ageing/afag224](https://doi.org/10.1093%2Fageing%2Fafag224)
- **Published At:** 2026-08-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This is a post hoc, age-stratified secondary analysis of the randomised ADAPT AF-DES trial comparing **NOAC monotherapy** with **NOAC plus clopidogrel** in patients with **atrial fibrillation** who received **drug-eluting stents**. - The trial enrolled 960 patients; 376 (39.2%) were aged ≥75 years. - NOACs used were **apixaban** or **rivaroxaban**; the combination arm added clopidogrel. - The prespecified primary endpoint was a 1-year net adverse clinical event composite: all-cause death, myocardial infarction, stent thrombosis, stroke, systemic embolism, or major/clinically relevant non-major bleeding per ISTH criteria. - In patients aged ≥75 years, the primary endpoint occurred less often with NOAC monotherapy versus combination therapy (9.8% vs 22.3%; adjusted HR 0.37; 95% CI 0.21–0.66; P < .001). - In patients aged <75 years, there was no significant difference in the primary endpoint between strategies. - The interaction between age group and treatment strategy for the primary endpoint did not reach statistical significance (P for interaction = 0.095). - Reduction in major or clinically relevant non-major bleeding with NOAC monotherapy was consistent across age groups. - The benefit of NOAC monotherapy on major adverse cardiac and cerebrovascular events was more pronounced in patients aged ≥75 years, with a statistically significant interaction reported. - The authors conclude that NOAC monotherapy was associated with lower net adverse clinical events in older patients and suggest age and individual ischemic risk should inform antithrombotic strategy. - Specific trial details such as randomisation timing, dosing regimens, duration of dual therapy before monotherapy (if any), and subgroup event counts beyond those reported were not provided in the source abstract.
## Clinical Analysis & Structured Key Points
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[Sang-Hyup Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+SH&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Soo-Jin Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+SJ&cauthor_id=42546025)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-2 "Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea."), [Ae-Young Her](https://pubmed.ncbi.nlm.nih.gov/?term=Her+AY&cauthor_id=42546025)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-3 "Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea."), [Byung-Ryul Cho](https://pubmed.ncbi.nlm.nih.gov/?term=Cho+BR&cauthor_id=42546025)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-3 "Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea."), [Gwang-Sil Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+GS&cauthor_id=42546025)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-4 "Inje University Sanggye Paik Hospital, Division of Cardiology, Seoul, Nowon-gu, Republic of Korea."), [Taek-Geun Kwon](https://pubmed.ncbi.nlm.nih.gov/?term=Kwon+TG&cauthor_id=42546025)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-5 "Chungbuk National University Hospital, Division of Cardiology, Cheongju-si, Chungcheongbuk-do, Republic of Korea."), [Sang-Wook Lim](https://pubmed.ncbi.nlm.nih.gov/?term=Lim+SW&cauthor_id=42546025)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-6 "CHA University Bundang Medical Center, Division of Cardiology, Seongnam-si, Gyeonggi-do, Republic of Korea."), [Jaemin Shim](https://pubmed.ncbi.nlm.nih.gov/?term=Shim+J&cauthor_id=42546025)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-7 "Korea University Anam Hospital, Division of Cardiology, Seoul, Republic of Korea."), [Ji-Yong Jang](https://pubmed.ncbi.nlm.nih.gov/?term=Jang+JY&cauthor_id=42546025)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-8 "National Health Insurance Service Ilsan Hospital, Division of Cardiology, Goyang-si, Gyeonggi-do, Republic of Korea."), [Yong-Joon Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+YJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Seung-Jun Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+SJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Hee Tae Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+HT&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Sung-Jin Hong](https://pubmed.ncbi.nlm.nih.gov/?term=Hong+SJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Chul-Min Ahn](https://pubmed.ncbi.nlm.nih.gov/?term=Ahn+CM&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Byeong-Keuk Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+BK&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Young-Guk Ko](https://pubmed.ncbi.nlm.nih.gov/?term=Ko+YG&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Donghoon Choi](https://pubmed.ncbi.nlm.nih.gov/?term=Choi+D&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Myeong-Ki Hong](https://pubmed.ncbi.nlm.nih.gov/?term=Hong+MK&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Yangsoo Jang](https://pubmed.ncbi.nlm.nih.gov/?term=Jang+Y&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Hui-Nam Pak](https://pubmed.ncbi.nlm.nih.gov/?term=Pak+HN&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Jung-Sun Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+JS&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Jung Ho Heo](https://pubmed.ncbi.nlm.nih.gov/?term=Heo+JH&cauthor_id=42546025)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#full-view-affiliation-2 "Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea.") Affiliations Expand ### Affiliations * 1 Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea. * 2 Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea. * 3 Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea. * 4 Inje University Sanggye Paik Hospital, Division of Cardiology, Seoul, Nowon-gu, Republic of Korea. * 5 Chungbuk National University Hospital, Division of Cardiology, Cheongju-si, Chungcheongbuk-do, Republic of Korea. * 6 CHA University Bundang Medical Center, Division of Cardiology, Seongnam-si, Gyeonggi-do, Republic of Korea. * 7 Korea University Anam Hospital, Division of Cardiology, Seoul, Republic of Korea. * 8 National Health Insurance Service Ilsan Hospital, Division of Cardiology, Goyang-si, Gyeonggi-do, Republic of Korea. * PMID: **42546025** * DOI: [ 10.1093/ageing/afag224 ](https://doi.org/10.1093/ageing/afag224) Item in Clipboard Randomized Controlled Trial # Antithrombotic strategy according to age in patients with atrial fibrillation and drug-eluting stents: a post hoc analysis of the ADAPT AF-DES randomised trial Sang-Hyup Lee et al. Age Ageing. 2026. Show details Display options Display options Format Abstract PubMed PMID Age Ageing Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Age+Ageing%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Age+Ageing%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42546025/) . 2026 Aug 3;55(8):afag224. doi: 10.1093/ageing/afag224. ### Authors [Sang-Hyup Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+SH&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Soo-Jin Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+SJ&cauthor_id=42546025)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-2 "Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea."), [Ae-Young Her](https://pubmed.ncbi.nlm.nih.gov/?term=Her+AY&cauthor_id=42546025)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-3 "Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea."), [Byung-Ryul Cho](https://pubmed.ncbi.nlm.nih.gov/?term=Cho+BR&cauthor_id=42546025)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-3 "Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea."), [Gwang-Sil Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+GS&cauthor_id=42546025)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-4 "Inje University Sanggye Paik Hospital, Division of Cardiology, Seoul, Nowon-gu, Republic of Korea."), [Taek-Geun Kwon](https://pubmed.ncbi.nlm.nih.gov/?term=Kwon+TG&cauthor_id=42546025)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-5 "Chungbuk National University Hospital, Division of Cardiology, Cheongju-si, Chungcheongbuk-do, Republic of Korea."), [Sang-Wook Lim](https://pubmed.ncbi.nlm.nih.gov/?term=Lim+SW&cauthor_id=42546025)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-6 "CHA University Bundang Medical Center, Division of Cardiology, Seongnam-si, Gyeonggi-do, Republic of Korea."), [Jaemin Shim](https://pubmed.ncbi.nlm.nih.gov/?term=Shim+J&cauthor_id=42546025)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-7 "Korea University Anam Hospital, Division of Cardiology, Seoul, Republic of Korea."), [Ji-Yong Jang](https://pubmed.ncbi.nlm.nih.gov/?term=Jang+JY&cauthor_id=42546025)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-8 "National Health Insurance Service Ilsan Hospital, Division of Cardiology, Goyang-si, Gyeonggi-do, Republic of Korea."), [Yong-Joon Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+YJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Seung-Jun Lee](https://pubmed.ncbi.nlm.nih.gov/?term=Lee+SJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Hee Tae Yu](https://pubmed.ncbi.nlm.nih.gov/?term=Yu+HT&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Sung-Jin Hong](https://pubmed.ncbi.nlm.nih.gov/?term=Hong+SJ&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Chul-Min Ahn](https://pubmed.ncbi.nlm.nih.gov/?term=Ahn+CM&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Byeong-Keuk Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+BK&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Young-Guk Ko](https://pubmed.ncbi.nlm.nih.gov/?term=Ko+YG&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Donghoon Choi](https://pubmed.ncbi.nlm.nih.gov/?term=Choi+D&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Myeong-Ki Hong](https://pubmed.ncbi.nlm.nih.gov/?term=Hong+MK&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Yangsoo Jang](https://pubmed.ncbi.nlm.nih.gov/?term=Jang+Y&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Hui-Nam Pak](https://pubmed.ncbi.nlm.nih.gov/?term=Pak+HN&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Jung-Sun Kim](https://pubmed.ncbi.nlm.nih.gov/?term=Kim+JS&cauthor_id=42546025)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-1 "Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea."), [Jung Ho Heo](https://pubmed.ncbi.nlm.nih.gov/?term=Heo+JH&cauthor_id=42546025)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42546025/#short-view-affiliation-2 "Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea.") ### Affiliations * 1 Yonsei University College of Medicine, Division of Cardiology, Seodaemun-gu, Seoul, Republic of Korea. * 2 Kosin University Gospel Hospital, Division of Cardiology, Busan, Republic of Korea. * 3 Kangwon National University Hospital, Division of Cardiology, Chuncheon-si, Gangwon-do, Republic of Korea. * 4 Inje University Sanggye Paik Hospital, Division of Cardiology, Seoul, Nowon-gu, Republic of Korea. * 5 Chungbuk National University Hospital, Division of Cardiology, Cheongju-si, Chungcheongbuk-do, Republic of Korea. * 6 CHA University Bundang Medical Center, Division of Cardiology, Seongnam-si, Gyeonggi-do, Republic of Korea. * 7 Korea University Anam Hospital, Division of
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