Key result
Edoxaban de-escalation linked to ~15-point lower 12-month bleeding vs continuous dual antithrombotic therapy.
Why the study?
The optimal perioperative antithrombotic strategy for patients with atrial fibrillation undergoing carotid artery stenting remains uncertain, particularly regarding safety and efficacy of edoxaban-based de-escalation versus continuous dual therapy.
Does an edoxaban-based de-escalation strategy reduce bleeding risk and maintain efficacy compared to continuous dual antithrombotic therapy in patients with atrial fibrillation undergoing carotid artery stenting?
Cohort (n=120)
No
Does an edoxaban-based de-escalation strategy reduce bleeding risk and maintain efficacy compared to continuous dual antithrombotic therapy in patients with atrial fibrillation undergoing carotid artery stenting?
Absolute Event Rate: 8.93% vs 23.44%
p-value: p=0.033
An edoxaban-based de-escalation strategy (dropping aspirin at 6 months) safely reduces bleeding risk while maintaining antithrombotic efficacy in patients with AF undergoing carotid artery stenting.
Edoxaban de-escalation may lower bleeding after carotid stenting in AF; hypothesis-generating and requires randomized confirmation.
OBJECTIVE: To compare the safety and efficacy of an edoxaban-based, time-limited dual antithrombotic therapy followed by a de-escalation strategy versus a continuous dual antithrombotic strategy in patients with atrial fibrillation (AF) undergoing carotid artery stenting (CAS). METHODS: A total of 120 patients with CAS and AF who underwent surgery at Guizhou Panjiang Investment Holding (Group) Co., Ltd. General Hospital from June 2023 to December 2024 were retrospectively enrolled. According to the perioperative antithrombotic regimen, patients were divided into a de-escalation group (n=56) and a dual therapy group (n=64). Patients in the de-escalation group received edoxaban (standard dose) combined with aspirin (100 mg/d) preoperatively and during the first 6 months postoperatively, after which aspirin was discontinued and edoxaban monotherapy was continued from 6 to 12 months postoperatively. Patients in the dual therapy group received continuous treatment with edoxaban plus aspirin throughout the 12-month follow-up period. Platelet count, C-reactive protein (CRP), D-dimer, fibrinogen, and coagulation parameters, including prothrombin time (PT), thrombin time (TT), and activated partial thromboplastin time (APTT), were compared at 1, 6, and 12 months postoperatively. Bleeding events, embolic events, adverse reactions, carotid artery restenosis, stent thrombosis, health-related quality of life (EQ-5D-5L), and treatment adherence were recorded. RESULTS: =0.047). CONCLUSION: In patients with AF undergoing CAS, an edoxaban-based de-escalation strategy involving conversion to monotherapy at 6 months postoperatively was non-inferior to continuous dual antithrombotic therapy in preventing ischemic events. This strategy significantly reduced bleeding risk at 12 months postoperatively and improved quality of life and treatment adherence, representing a safe and effective perioperative antithrombotic management regimen.
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Li et al. (2026) conducted a cohort in Atrial fibrillation undergoing carotid artery stenting (n=120). Edoxaban-based de-escalation strategy (edoxaban plus aspirin) vs. Continuous dual antithrombotic therapy (edoxaban plus aspirin) was evaluated on Overall bleeding events at 12 months (p=0.033). An edoxaban-based de-escalation strategy significantly reduced the incidence of overall bleeding events at 12 months compared to continuous dual antithrombotic therapy (8.93% vs 23.44%, p=0.033).
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