N Engl J Med

ESC 2024: DOAC monotherapy vs. dual antithrombotic therapy in patients with afib and CAD

September 5, 2024

In patients with afib and stable coronary artery disease (CAD), edoxaban monotherapy led to a lower risk of a composite of death from any cause, MI, stroke, systemic embolism, unplanned urgent revascularization, or major bleeding or clinically relevant nonmajor bleeding at 12 months than dual antithrombotic therapy. These findings were presented at the recent European Society of Cardiology meeting in London.

• The open-label, randomized EPIC-CAD trial compared edoxaban monotherapy (n=524) with dual antithrombotic therapy (edoxaban plus a single antiplatelet agent) (n=516) in patients with afib and stable CAD. Stroke risk was assessed based on CHA2DS2-VASc score (scores range from 0 to 9, with higher scores indicating a greater risk of stroke). Primary outcome was a composite of death from any cause, MI, stroke, systemic embolism, unplanned urgent revascularization, and major bleeding or clinically relevant nonmajor bleeding at 12 months. Secondary outcomes included a composite of major ischemic events and the safety outcome of major bleeding or clinically relevant nonmajor bleeding.
• At 12 months, a primary-outcome event had occurred in 6.8% of patients assigned to edoxaban monotherapy vs. 16.2% assigned to dual antithrombotic therapy. The cumulative incidence of major ischemic events at 12 months was similar between groups.
• Major bleeding or clinically relevant nonmajor bleeding occurred in 4.7% of patients in the edoxaban monotherapy group and in 14.2% in the dual antithrombotic therapy group (HR, 0.34; 95% CI, 0.22-0.53).

Source:

Cho MS, et al; EPIC-CAD Investigators. (2024, September 1). N Engl J Med. Edoxaban Antithrombotic Therapy for Atrial Fibrillation and Stable Coronary Artery Disease. https://pubmed.ncbi.nlm.nih.gov/39225258/