Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease
Background. Current guidelines recommend an oral anticoagulant (OAC) monotherapy in patients with nonvalvular atrial fibrillation (NVAF) and stable coronary artery disease (CAD) 1 year postpercutaneous coronary intervention (PCI). It might be possible to shorten the time for de-escalation from a dua...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Hindawi-Wiley
2022-01-01
|
| Series: | Journal of Interventional Cardiology |
| Online Access: | http://dx.doi.org/10.1155/2022/5905022 |
| _version_ | 1797977036265881600 |
|---|---|
| author | Daisuke Fukamachi Yasuo Okumura Naoya Matsumoto Eizo Tachibana Koji Oiwa Makoto Ichikawa Hironori Haruta Kazumiki Nomoto Ken Arima Atsushi Hirayama |
| author_facet | Daisuke Fukamachi Yasuo Okumura Naoya Matsumoto Eizo Tachibana Koji Oiwa Makoto Ichikawa Hironori Haruta Kazumiki Nomoto Ken Arima Atsushi Hirayama |
| author_sort | Daisuke Fukamachi |
| collection | DOAJ |
| description | Background. Current guidelines recommend an oral anticoagulant (OAC) monotherapy in patients with nonvalvular atrial fibrillation (NVAF) and stable coronary artery disease (CAD) 1 year postpercutaneous coronary intervention (PCI). It might be possible to shorten the time for de-escalation from a dual therapy to monotherapy, but data regarding de-escalation to an edoxaban monotherapy are lacking. This study aimed to assess the clinical safety of an edoxaban monotherapy in patients with NVAF and stable CAD. Methods. A multicenter, prospective, randomized, open-label, and parallel group study was established to investigate the safety of an edoxaban monotherapy in patients with NVAF and stable CAD including over 6 months postimplantation of a third-generation DES and 1 year postimplantation of other stents (PRAEDO AF study). Between March 2018 and June 2020, 147 patients from 8 institutions in Japan were randomized to receive either an edoxaban monotherapy (n = 74) or combination therapy (edoxaban plus clopidogrel, n = 73). The primary study endpoint was the composite incidence of major bleeding and clinically significant bleeding, defined according to the ISTH criteria. Results. Major or clinically significant bleeding occurred in 2 patients in the monotherapy group (1.67% per patient-year) and in 5 patients in the combination therapy group (4.28% per patient-year) (hazard ratio, 0.39; 95% confidence interval, 0.08–2.02). There was no incidence of a myocardial infarction, stent thrombosis, unstable angina requiring revascularization, ischemic stroke, systemic stroke, or hemorrhagic stroke in either of the groups. Conclusions. The edoxaban monotherapy was shown to have acceptable clinical safety in patients with NVAF and stable CAD. The study was registered with the Japan Registry of Clinical Trials (jRCTs031180119). |
| first_indexed | 2024-04-11T05:00:35Z |
| format | Article |
| id | doaj.art-1879572ad7a94490bb4b411459d26c9a |
| institution | Directory Open Access Journal |
| issn | 1540-8183 |
| language | English |
| last_indexed | 2024-04-11T05:00:35Z |
| publishDate | 2022-01-01 |
| publisher | Hindawi-Wiley |
| record_format | Article |
| series | Journal of Interventional Cardiology |
| spelling | doaj.art-1879572ad7a94490bb4b411459d26c9a2022-12-26T01:12:51ZengHindawi-WileyJournal of Interventional Cardiology1540-81832022-01-01202210.1155/2022/5905022Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery DiseaseDaisuke Fukamachi0Yasuo Okumura1Naoya Matsumoto2Eizo Tachibana3Koji Oiwa4Makoto Ichikawa5Hironori Haruta6Kazumiki Nomoto7Ken Arima8Atsushi Hirayama9Division of CardiologyDivision of CardiologyDepartment of CardiologyKawaguchi Municipal Medical CenterYokohama Central HospitalSekishindo HospitalTMG Asaka HospitalTokyo Rinkai HospitalKasukabe Municipal HospitalOsaka Police HospitalBackground. Current guidelines recommend an oral anticoagulant (OAC) monotherapy in patients with nonvalvular atrial fibrillation (NVAF) and stable coronary artery disease (CAD) 1 year postpercutaneous coronary intervention (PCI). It might be possible to shorten the time for de-escalation from a dual therapy to monotherapy, but data regarding de-escalation to an edoxaban monotherapy are lacking. This study aimed to assess the clinical safety of an edoxaban monotherapy in patients with NVAF and stable CAD. Methods. A multicenter, prospective, randomized, open-label, and parallel group study was established to investigate the safety of an edoxaban monotherapy in patients with NVAF and stable CAD including over 6 months postimplantation of a third-generation DES and 1 year postimplantation of other stents (PRAEDO AF study). Between March 2018 and June 2020, 147 patients from 8 institutions in Japan were randomized to receive either an edoxaban monotherapy (n = 74) or combination therapy (edoxaban plus clopidogrel, n = 73). The primary study endpoint was the composite incidence of major bleeding and clinically significant bleeding, defined according to the ISTH criteria. Results. Major or clinically significant bleeding occurred in 2 patients in the monotherapy group (1.67% per patient-year) and in 5 patients in the combination therapy group (4.28% per patient-year) (hazard ratio, 0.39; 95% confidence interval, 0.08–2.02). There was no incidence of a myocardial infarction, stent thrombosis, unstable angina requiring revascularization, ischemic stroke, systemic stroke, or hemorrhagic stroke in either of the groups. Conclusions. The edoxaban monotherapy was shown to have acceptable clinical safety in patients with NVAF and stable CAD. The study was registered with the Japan Registry of Clinical Trials (jRCTs031180119).http://dx.doi.org/10.1155/2022/5905022 |
| spellingShingle | Daisuke Fukamachi Yasuo Okumura Naoya Matsumoto Eizo Tachibana Koji Oiwa Makoto Ichikawa Hironori Haruta Kazumiki Nomoto Ken Arima Atsushi Hirayama Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease Journal of Interventional Cardiology |
| title | Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease |
| title_full | Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease |
| title_fullStr | Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease |
| title_full_unstemmed | Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease |
| title_short | Edoxaban Monotherapy in Nonvalvular Atrial Fibrillation Patients with Coronary Artery Disease |
| title_sort | edoxaban monotherapy in nonvalvular atrial fibrillation patients with coronary artery disease |
| url | http://dx.doi.org/10.1155/2022/5905022 |
| work_keys_str_mv | AT daisukefukamachi edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT yasuookumura edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT naoyamatsumoto edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT eizotachibana edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT kojioiwa edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT makotoichikawa edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT hironoriharuta edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT kazumikinomoto edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT kenarima edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease AT atsushihirayama edoxabanmonotherapyinnonvalvularatrialfibrillationpatientswithcoronaryarterydisease |