Edoxaban Monotherapy in Patients with Atrial Fibrillation and Stable Coronary Artery Disease

Patients with atrial fibrillation (Afib) and stable coronary artery disease (CAD) often require antithrombotic therapy to prevent adverse events such as stroke, myocardial infarction, and bleeding. Recent evidence from the EPIC-CAD trial suggests that edoxaban monotherapy may offer improved net outcomes compared to dual antithrombotic therapy in this patient population.

The EPIC-CAD trial demonstrated that patients treated with edoxaban monotherapy had a lower incidence of composite outcomes, including death, myocardial infarction, stroke, systemic embolism, unplanned revascularization, and major bleeding, compared to those receiving dual antithrombotic therapy. The difference was primarily driven by a reduction in bleeding events, with no significant difference in major ischemic events between the two groups.

The results of the EPIC-CAD trial support current guidelines that recommend oral anticoagulation alone in patients with CAD after percutaneous coronary intervention (PCI) or acute coronary syndrome. The findings suggest that transitioning to a single antithrombotic agent may reduce bleeding risk without increasing the risk of ischemic events.

While the evidence from the EPIC-CAD trial is compelling, there are still challenges in determining the optimal timing for transitioning to single-agent therapy in patients with Afib and stable CAD. Clinicians must carefully weigh the risks and benefits of antithrombotic regimens to individualize treatment decisions.

It is important to note that the EPIC-CAD trial was underpowered to assess thrombotic events as a primary endpoint. Additionally, the study primarily included Asian patients, and the generalizability of the findings to non-Asian populations may be limited.

The findings of the EPIC-CAD trial provide valuable insights into the use of edoxaban monotherapy in patients with Afib and stable CAD. Clinicians should consider these results when making treatment decisions for this patient population and continue to follow current guidelines for antithrombotic therapy in CAD. Further research is needed to explore the long-term safety and efficacy of edoxaban monotherapy in diverse patient populations.