A recent study conducted at Asan Medical Center in Seoul, South Korea, revealed some groundbreaking results regarding the use of edoxaban (Savaysa) monotherapy in patients with atrial fibrillation (Afib) and stable coronary artery disease (CAD). The EPIC-CAD trial compared the outcomes of patients on edoxaban monotherapy versus those on dual antithrombotic therapy and found that the former group experienced superior net outcomes when considering both bleeding and ischemic events.
The 12-month composite endpoint, which included death from any cause, myocardial infarction, stroke, systemic embolism, unplanned urgent revascularization, major bleeding, or clinically relevant nonmajor bleeding, occurred in 6.8% of patients on edoxaban monotherapy compared to 16.2% of those on dual antithrombotic therapy. The difference was predominantly driven by a lower incidence of bleeding in the edoxaban monotherapy group, with no significant variance in major ischemic events between the two groups.
Dr. Marco Valgimigli, a study discussant at the European Society of Cardiology (ESC) meeting, emphasized the importance of these findings in guiding clinical decision-making. The results of the EPIC-CAD trial align with current guidelines that recommend oral anticoagulation alone for 6-12 months post-percutaneous coronary intervention (PCI) or acute coronary syndrome. This study adds to the existing body of evidence supporting single antithrombotic therapy over dual therapy in CAD patients.
Despite the promising results of the EPIC-CAD trial, Dr. Valgimigli highlighted some challenges in interpreting the primary endpoint, particularly with regards to the inclusion of revascularization in the outcome assessment. The study, which included a predominantly Asian cohort, was underpowered for assessing thrombotic events alone, suggesting the need for further research in more diverse populations.
The EPIC-CAD trial sheds light on the potential benefits of edoxaban monotherapy in patients with Afib and stable CAD. The findings underscore the importance of reevaluating current treatment practices and considering the transition to a single antithrombotic agent in eligible patients. While more research is needed to confirm these results in broader populations, the study offers valuable insights into optimizing care for this patient population.