Impact of stable coronary artery disease on anticoagulation monotherapy in patients with nonvalvular atrial fibrillation: a propensity score-matched analysis

doi:10.5246/jcps.2025.11.074

Journal of Chinese Pharmaceutical Sciences ›› 2025, Vol. 34 ›› Issue (11): 989-1002.DOI: 10.5246/jcps.2025.11.074

• Original articles • Previous Articles Next Articles

Impact of stable coronary artery disease on anticoagulation monotherapy in patients with nonvalvular atrial fibrillation: a propensity score-matched analysis

Mingyu Chen¹^,²^,^#, Youqi Huang¹^,³^,^#, Jinzhu Deng⁴, Yuqi Lin⁴, Hongjin Gao¹^,^*(), Min Chen¹^,^*()

¹ Department of Pharmacy, Shengli Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou 350001, Fujian, China
² Department of Pharmacy, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, Fujian, China
³ Longyan Pharmaceutical Inspection and Testing Center, Longyan 364000, Fujian, China
⁴ School of Pharmacy, Fujian Medical University, Fuzhou 350004, Fujian, China

Received:2025-07-18 Revised:2025-08-20 Accepted:2025-09-11 Online:2025-12-02 Published:2025-12-02
Contact: Hongjin Gao, Min Chen
About author:
^# Mingyu Chen and Youqi Huang contributed equally to this work.
Supported by:
The Guiding Projects issued by the Fujian Provincial Department of Science and Technology, China (Grant No. 2023Y0045); the Department of Finance, Fujian Province (Grant No. 006009210417); and the Fujian Medical University Student Innovation Training Program (Grant No. C2024177); Joint Funds for the Innovation of Science and Technology, Fujian Province (Grant No. 2024Y9009).

Abstract

Abstract:

This study aimed to investigate the influence of stable coronary artery disease (SCAD) on anticoagulation monotherapy. A total of 260 patients with nonvalvular atrial fibrillation who were admitted to Fujian Provincial Hospital between November 2021 and June 2023 were enrolled. The study compared the trough plasma concentrations of rivaroxaban, coagulation parameters, efficacy endpoints (stroke, systemic embolism, and myocardial infarction [MI]), and safety outcomes (including major bleeding, clinically relevant nonmajor bleeding [CRB], minor bleeding, and overall bleeding) between SCAD and non-SCAD patients after propensity score matching (PSM). Additionally, the association between prothrombin time-international normalized ratio (PT-INR) and total bleeding risk was analyzed using restricted cubic spline models and Cox proportional hazards regression. Baseline characteristics, including ABCB1 genotypes, concomitant medications, and other clinical variables, were retrospectively collected. Following PSM, 159 patients were included in the final analysis. The results indicated no significant differences in efficacy outcomes or CRB between SCAD and non-SCAD patients. However, SCAD patients exhibited a significantly higher risk of minor bleeding (adjusted HR: 2.08, 95% CI: 1.07–4.04; P = 0.030) and total bleeding (HR: 1.96, 95% CI: 1.05–3.64; P = 0.034). Moreover, among SCAD patients with a history of MI, the risk of CRB (HR: 5.50, 95% CI: 1.00–30.14; P = 0.0497) and total bleeding (HR: 2.61, 95% CI: 1.09–6.27; P = 0.032) was notably increased. Furthermore, in SCAD patients, PT-INR demonstrated a nonlinear positive correlation with total bleeding risk.

Key words: Coronary artery disease, Atrial fibrillation, Anticoagulants, Hemorrhage

Supporting: /attached/file/20251130/20251130160049_815.pdf

Mingyu Chen, Youqi Huang, Jinzhu Deng, Yuqi Lin, Hongjin Gao, Min Chen. Impact of stable coronary artery disease on anticoagulation monotherapy in patients with nonvalvular atrial fibrillation: a propensity score-matched analysis[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(11): 989-1002.

Figures/Tables 7

Table 1. Baseline characteristics stratified by stable CAD before and after PSM.

Table 2. Efficacy and safety endpoint events in patients with NVAF after PSM.

Table 3. Associations between PT-INR and total bleeding events in patients with NVAF and SCAD.

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Impact of stable coronary artery disease on anticoagulation monotherapy in patients with nonvalvular atrial fibrillation: a propensity score-matched analysis

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