The EPIC-CAD trial conducted by Gi-Byoung Nam, MD, at the Asan Medical Center in Seoul, South Korea, presented findings that showed promising results for patients with atrial fibrillation (Afib) and stable coronary artery disease (CAD). The study compared the efficacy of edoxaban monotherapy versus dual antithrombotic therapy in improving net outcomes by considering bleeding and ischemic events. The results were presented at the European Society of Cardiology (ESC) meeting and simultaneously published in the New England Journal of Medicine.
Key Findings of the Study
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 primarily driven by a significant reduction in bleeding events with edoxaban monotherapy. Major bleeding or clinically relevant nonmajor bleeding were reported in 4.7% of the edoxaban group and 14.2% of the dual antithrombotic therapy group.
The findings of the EPIC-CAD trial support the existing guidelines from ESC and the American Heart Association/American College of Cardiology, which recommend oral anticoagulation alone 6-12 months after percutaneous coronary intervention (PCI) or acute coronary syndrome. The trial adds to the body of evidence supporting single antithrombotic therapy over dual therapy in patients with CAD, with or without PCI.
While the results of the EPIC-CAD trial are promising, there are some limitations to consider. The study was underpowered for thrombotic events as a sole endpoint, and the timing of transitioning to a single agent after the early post-event period remains unclear. Additionally, the interpretation of the primary endpoint, which included revascularization, may be challenging in patients with a history of prior revascularization.
The EPIC-CAD trial provides valuable insights into the management of patients with Afib and stable CAD. The study demonstrates a clear benefit of edoxaban monotherapy in reducing bleeding events compared to dual antithrombotic therapy. Clinicians are encouraged to consider these findings when making treatment decisions for this patient population. Further research is needed to determine the optimal timing for transitioning to single antithrombotic therapy and to address the challenges identified in this study.
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