Abstract Th0021: Edoxaban Monotherapy versus Dual Antithrombotic Therapy (DAT) in Atrial fibrillation with Stable CAD: A Meta-Analysis of EPIC-CAD and PRAEDO-AF Trials

Background: Current guidelines recommend dual antithrombotic therapy (DAT) for patients with atrial fibrillation (AF) and stable coronary artery disease (CAD). However, recent trials suggest edoxaban monotherapy as an equally effective and safer alternative to DAT. We performed a meta-analysis to pool all randomized controlled trials (RCTs) comparing edoxaban with DAT in this population. Methods: Pubmed, Embase, and Cochrane Central were searched to identify all relevant articles. A bivariate random effects model was applied and statistical analyses were performed using RevMan 4.5. A revised Cochrane risk-of-bias tool was used to assess the quality of studies. Results: Two RCTs with a total of 1,187 patients (18% females, mean age 73 years) were included. The results showed that patients receiving edoxaban monotherapy had a significantly reduced risk of major or clinically relevant non-major bleeding (RR 0.33; 95% CI 0.21-0.51; p=<0.00001) and net adverse clinical events (NACE) (RR 0.47; 95% CI 0.29-0.75; p=0.002) compared to the DAT group. However, all-cause mortality (RR 1.43; 95% CI 0.39-5.23; p=0.59), cardiovascular mortality (RR 2.38; 95% CI 0.34-15.49; p=0.40), and major ischemic events (RR 1.17; 95% CI 0.48-2.86; p=0.73) were comparable between the two groups. Both trials were rated as low risk. Conclusion: In patients with AF and stable CAD, OAC monotherapy reduced the risk of major or clinically relevant non-major bleeding and NACE, with no significant difference in all-cause mortality, cardiovascular mortality or major ischemic events between the two groups.