Key result
Edoxaban monotherapy cuts major events ~56% vs dual therapy in AF and CAD regardless of diabetes.
Why the study?
The appropriate antithrombotic regimen for diabetic patients with AF and stable CAD at high atherothrombotic risk remains uncertain.
Does edoxaban monotherapy reduce adverse clinical and bleeding events compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
RCT (n=1,040)
randomized
Does edoxaban monotherapy reduce adverse clinical and bleeding events compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease?
Edoxaban monotherapy significantly reduces the risk of a composite of adverse clinical and bleeding events compared to dual antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease, regardless of diabetes status.
Answers are grounded in this paper and cite their sources.
Supports edoxaban monotherapy over dual therapy in AF with stable CAD regardless of diabetes; confirms consistent benefit without interaction in this RCT.
Aims The appropriate antithrombotic regimen for diabetic patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) who are at high atherothrombotic risk remains uncertain. We evaluated whether the effects of different antithrombotic strategies differ according to diabetes status. Methods and Results The EPIC-CAD (Edoxaban versus Edoxaban with Antiplatelet Agent in Patients with Atrial Fibrillation and Chronic Stable Coronary Artery Disease) was a randomized trial comparing edoxaban monotherapy with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) in patients with AF and stable CAD. The primary outcome was a composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, and major or clinically relevant nonmajor bleeding at 12 months. Among 1040 randomized patients, 421 (40.5%) had diabetes. There were no differences in the incidence of the primary outcome between diabetic and non-diabetic patients (9.7% vs. 11.6%; hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.56-1.20; P=0.30). The incidence of the primary outcome at 12 months was significantly lower with edoxaban monotherapy than with dual antithrombotic therapy in both diabetic (6.3% vs. 13.7%; HR 0.44; 95% CI 0.23-0.83; P=0.01) and non-diabetic patients (6.7% vs. 16.3%; HR 0.39; 95% CI 0.23-0.65; P=0.001), with no significant interaction between diabetic status and randomized treatment strategy (P-for-interaction=0.78). Conclusions The risk of primary outcome was similar between diabetic and non-diabetic patients with AF and CAD. Irrespective of diabetes status, edoxaban monotherapy led to a lower risk of a primary outcome at 12 months than dual antithrombotic therapy.
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Lee et al. (2026) conducted an RCT in atrial fibrillation and stable coronary artery disease (n=1,040). edoxaban monotherapy vs. dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) was evaluated on composite of death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, and major or clinically relevant nonmajor bleeding at 12 months. Edoxaban monotherapy reduced the primary composite outcome compared to dual therapy in both diabetic and non-diabetic patients with AF and stable CAD.
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