A Clinical Framework for Antithrombotic Review in Anticoagulated Patients With Stable Coronary Artery Disease: When Should Aspirin Be Stopped?

Patients receiving oral anticoagulation (OAC) for atrial fibrillation frequently have concomitant coronary artery disease (CAD), raising questions about the duration of additional antiplatelet therapy.Triple antithrombotic therapy combines OAC with aspirin and a P2Y₁₂ inhibitor, usually clopidogrel, whereas dual antithrombotic therapy combines OAC with a single antiplatelet agent.Early aspirin withdrawal from triple therapy and subsequent withdrawal of the remaining antiplatelet are separate decisions requiring assessment of the coronary timeline and current treatment indications.This narrative editorial examines randomized evidence and proposes a structured medication review framework.The evidence generally supports OAC monotherapy in appropriately selected patients with stable CAD, with reduced bleeding and favourable net clinical outcomes compared with combined treatment.However, aspirin-specific findings require distinction from comparisons involving clopidogrel or mixed antiplatelet regimens.Overall trial results do not establish identical benefits or harms across patients with previous myocardial infarction, multivessel disease, or complex coronary intervention.Differences in eligibility and composite endpoints, geographic concentration, open-label designs, early termination in some trials, and limited precision for uncommon ischemic events constrain interpretation and generalizability.The proposed framework comprises verification of the OAC indication and regimen, establishment of the coronary timeline, assessment of any current antiplatelet indication, review of bleeding risks and drug interactions, and documentation of the decision, responsible clinician, and reassessment date.Extrapolation requires particular caution in patients with previous stent thrombosis, mechanical valves, or OAC prescribed for venous thromboembolism.Continued combination therapy requires a current, documented justification.The framework remains unvalidated, and its reproducibility, feasibility, and effects on prescribing, bleeding, and ischemic outcomes require prospective evaluation.