Impact of renal function on edoxaban antithrombotic therapy in patients with atrial fibrillation and stable coronary artery disease: a prespecified analysis of the EPIC-CAD trial
Year: 2026
Type: article
Abstract: BACKGROUND: Renal function is a critical factor of ischaemic and bleeding risks in patients with atrial fibrillation (AF) receiving antithrombotic therapy. AIMS: This study aimed to evaluate the impact of renal dysfunction in patients with AF and stable coronary artery disease (CAD) undergoing antithrombotic therapy. METHODS: The Edoxaban Versus Edoxaban With antiPlatelet Agent In Patients With Atrial Fibrillation and Chronic Stable Coronary Artery Disease (EPIC-CAD) trial randomised patients to edoxaban monotherapy or dual antithrombotic therapy (edoxaban plus a single antiplatelet agent). In this prespecified analysis, patients were stratified by creatinine clearance into low (<50 mL/min) or high (≥50 mL/min) groups according to edoxaban dose-reduction criteria. The primary endpoint was net adverse clinical events (NACE: death from any cause, myocardial infarction, stroke, systemic embolism, urgent revascularisation, or major/clinically relevant non-major bleeding) at 12 months. RESULTS: Of 1,040 randomised patients, 252 (24.2%) had low creatinine clearance; these patients were older and had more comorbidities compared with the 788 patients (75.8%) with high creatinine clearance. Patients with low creatinine clearance experienced higher risks of NACE (hazard ratio [HR] 1.72, 95% confidence interval [CI]: 1.19-2.49; p=0.004), ischaemic events (HR 2.70, 95% CI: 1.09-6.70; p=0.032), and bleeding (HR 1.54, 95% CI: 1.01-2.34; p=0.046). At 12 months, edoxaban monotherapy reduced NACE compared with dual therapy in both the low (12.1% vs 21.7%, HR 0.52, 95% CI: 0.28-0.98; p=0.042) and high creatinine clearance groups (5.2% vs 14.5%, HR 0.40, 95% CI: 0.25-0.65; p<0.001), with no interaction (p for interaction=0.53). CONCLUSIONS: In patients with AF and stable CAD, edoxaban monotherapy led to a lower risk of primary NACE than dual antithrombotic therapy, regardless of renal function. (ClinicalTrials.gov: NCT03718559).
Source: EuroIntervention
Authors: Joong Min Lee, Min Soo Cho, Do-Yoon Kang, Jung-Min Ahn, Yong-Seog Oh, Chang Hoon Lee, Eue-Keun Choi, Ji Hyun Lee, Chang Hee Kwon, Gyung-Min Park, Hyung Oh Choi, Kyoung-Ha Park, Kyoung-Min Park, Jongmin Hwang, Ki-Dong Yoo, Young-Rak Cho, Ji Hyun Kim, Ki Won Hwang, Eun-Sun Jin, Osung Kwon, Ki-Hun Kim, Seung-Jung Park, Gi-Byoung Nam, Duk-Woo Park
Institutions: Asan Medical Center, Seoul National University Bundang Hospital, University of Ulsan, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, Veterans Health Service Medical Center, Seoul National University, Seoul National University Hospital, Konkuk University, Konkuk University Medical Center, Ulsan University Hospital, Soonchunhyang University Hospital Bucheon, Samsung Medical Center, Hallym University Medical Center, Sungkyunkwan University, Keimyung University Dongsan Hospital, Keimyung University, The Catholic University of Korea St. Vincent's Hospital, Dong-A University Hospital, Dongguk University Ilsan Hospital, Pusan National University Yangsan Hospital, Kyung Hee University Hospital at Gangdong, Kyung Hee University Medical Hospital at Gangdong, The Catholic University of Korea Eunpyeong St. Mary's Hospital, Inje University, Inje University Haeundae Paik Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7154120246