For stable CAD patients with an indication for anticoagulation, what is the role of aspirin for 2* prevention of coronary events?
Very small. I looked this up a few years ago and found several trials looking at warfarin and aspirin which generally showed aspirin has no added benefit but does increase risk (ie warfarin is adequate for 2* prevention). At the time there were no good DOAC trials, but in looking now, I found the AFIRE trial, which you may have covered in Journal Club last year. It found that taking an anti-platelet agent conferred no additional benefit over rivaroxaban alone. With the given caveats - these patients weren't that sick, the study was mostly men, and it was done in Japan - I found this compelling data to reconsider anti-platelet therapy in patients who are already taking an anticoagulant and have been clinically stable for a few years.
Figure 2. Primary Efficacy and Safety End Points
Yasuda S, Kaikita K, Akao M, et al. Antithrombotic Therapy for Atrial Fibrillation with Stable Coronary Disease. New England Journal of Medicine. 2019;381(12):1103-1113. doi:https://doi.org/10.1056/nejmoa1904143
