New research presented at the American Heart Association's Scientific Sessions 2025 suggests that a simplified medication approach for preventing blood clots after stent placement in atrial fibrillation patients may offer similar protection against serious cardiovascular events while reducing bleeding risks. The study, known as the OPTIMA-AF trial, found that using two clot-preventing medications for just one month followed by a single medication for the remaining 11 months was equally effective at preventing stroke, heart attack and death compared to the standard year-long dual therapy regimen.
The findings are particularly significant given the growing population affected by atrial fibrillation, a common heart rhythm disorder that increases stroke risk 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 AFib, with projections suggesting more than 12 million Americans will be affected by 2030. Up to one in ten people who receive coronary stents also have AFib, making this treatment approach relevant to a substantial patient population.
Standard treatment after stent implantation typically involves prescribing two clot-preventing medications for one year: a direct oral anticoagulant such as dabigatran, rivaroxaban, apixaban or edoxaban to prevent strokes, and a P2Y12 inhibitor such as clopidogrel or prasugrel to prevent clots in the stent. However, these medications can increase the risk of serious bleeding complications, which is a particular concern for older adults who comprise much of this patient population.
Study author Yohei Sotomi, M.D., Ph.D., director of the Osaka Cardiovascular Conference Multicenter Clinical Research Lab at University of Osaka Graduate School of Medicine, explained that previous research had confirmed that using two anti-clotting agents instead of three reduced bleeding, but no study had tested whether the duration of dual therapy could be safely shortened to just one month. The current study is the first to demonstrate that this abbreviated approach provides both safety and effectiveness benefits.
Researchers studied more than 1,100 adults in Japan with an average age of 75.2 years, all of whom had atrial fibrillation and underwent procedures to implant drug-eluting stents. Participants were randomly assigned to either the one-month dual therapy regimen followed by single medication therapy or the standard 12-month dual therapy approach. The 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 notably, the shorter treatment duration resulted in significantly fewer bleeding complications: 4.8% in the one-month group versus 9.5% in the 12-month group. Most of this reduction came from fewer serious bleeds requiring medical attention, which can substantially impact quality of life and increase healthcare costs through emergency visits, clinic appointments, and diagnostic testing. The American Heart Association provides additional health information about atrial fibrillation and coronary artery stents at https://www.heart.org.
These findings could have important implications for clinical practice by giving physicians more confidence in prescribing shorter durations of dual antithrombotic therapy after stenting for certain AFib patients. By reducing exposure time to combination therapy, healthcare providers may be able to lower bleeding risks without compromising protection against stroke or heart attack. The study's abstract can be viewed in the American Heart Association Scientific Sessions 2025 Online Program Planner at https://professional.heart.org.
It is important to note that the study was conducted in Japan, so findings may not directly apply to populations in other countries. Additionally, most participants had stable heart disease, so results may not extend to patients with higher clotting risks. The study population was predominantly male (79%), limiting generalizability to women. The research was presented as an abstract at the American Heart Association's scientific meeting and has not yet undergone peer review, with findings considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
