Edoxaban monotherapy significantly reduced the total number of net adverse clinical events compared with dual therapy in patients with AF and stable CAD (IRR 0.47; 95% CI 0.34-0.67).
RCT (n=1,040)
randomized
Does edoxaban monotherapy reduce total net adverse clinical events compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
In patients with AF and stable CAD, edoxaban monotherapy significantly reduces the overall burden of clinical events, primarily driven by a reduction in bleeding, compared to dual antithrombotic therapy.
Effect estimate: IRR 0.47 (95% CI 0.34-0.67)
Absolute Event Rate: 9.4% vs 19.8%
p-value: p=<0.001
Background Oral anticoagulation (OAC) is essential for stroke prevention in atrial fibrillation (AF), whereas antiplatelet therapy remains standard for coronary artery disease (CAD), raising concerns about bleeding when both are combined. The effect of these regimens on recurrent events, reflecting cumulative disease burden, has not been fully evaluated. Methods This post‐hoc analysis of the EPIC‐CAD (Edoxaban vs. Edoxaban with antiPlatelet agent In patients with atrial fibrillation and Chronic stable Coronary Artery Disease) trial included 1,040 patients with AF and stable CAD randomized to edoxaban monotherapy or edoxaban plus a single antiplatelet agent. The primary endpoint was the total number of net adverse clinical events at 12 months. Results Over a median follow‐up of 12.1 months, 155 total events occurred (123 first, 32 subsequent). Event rates were lower with edoxaban monotherapy than with dual therapy (9.4 vs. 19.8 per 100 person‐years; incidence rate ratio IRR, 0.47; 95% CI, 0.34–0.67). Monotherapy reduced first events (IRR, 0.46; 95% CI, 0.32–0.68) and showed a lower cumulative hazard of total events (hazard ratio, 0.48; 95% CI, 0.32–0.71; P <0.001). Bleeding was the predominant event type in both groups but occurred more often with dual therapy (85.7% vs. 55.3%; P <0.001). Rates of ischemic events and mortality were similar between groups. Conclusions Edoxaban monotherapy significantly reduced the overall burden of clinical events compared with dual antithrombotic therapy in patients with AF and stable CAD. Bleeding complications were more frequent than ischemic events, emphasizing the need to minimize bleeding risk in this population.
Kim et al. (Thu,) conducted a rct in Atrial fibrillation and stable coronary artery disease (n=1,040). Edoxaban monotherapy vs. Edoxaban plus a single antiplatelet agent was evaluated on Total number of net adverse clinical events at 12 months (IRR 0.47, 95% CI 0.34-0.67, p=<0.001). Edoxaban monotherapy significantly reduced the total number of net adverse clinical events compared with dual therapy in patients with AF and stable CAD (IRR 0.47; 95% CI 0.34-0.67).