CLINICAL QUESTION

In patients with atrial fibrillation (AF) and stable coronary artery disease (CAD), does edoxaban (Savaysa) alone prevent more adverse outcomes than edoxaban plus an antiplatelet agent?

BOTTOM LINE

For patients with AF and stable CAD, edoxaban monotherapy prevents more adverse outcomes (mostly fewer major bleeding events) than edoxaban plus an antiplatelet agent. The net benefit is less clear for women than for men. (Level of Evidence = 1b)

SYNOPSIS

Based on randomized trials of patients with AF who experienced an acute episode of unstable angina, initial therapy with a direct oral anticoagulant plus a P2Y₁₂ inhibitor is recommended for 6 to 12 months, followed by a direct oral anticoagulant alone. This study randomized 1,040 Korean adults with prevalent (45%) or paroxysmal (55%) AF; stable CAD; and a CHA₂DS₂-VASc (congestive heart failure, hypertension, age ≥ 75 [doubled], diabetes, stroke [doubled], vascular disease, age 65 to 74, sex [female]) score of 2 or greater, indicating a moderate or worse risk of stroke. Stable CAD was defined as heart disease treated with percutaneous coronary intervention or bypass surgery at least 6 months earlier, an acute coronary syndrome treated with percutaneous coronary intervention or bypass at least 12 months earlier, or at least 50% stenosis of at least one coronary artery on angiogram. People at high risk of bleeding, those with a history of liver or kidney dysfunction, or a history of intracerebral hemorrhage were excluded.