Design and Rational for a Prospective Randomized Study of Safety Outcomes Treated with Edoxaban in Patients with Stable Coronary Artery Disease and Atrial Fibrillation (PRAEDO AF Study)

Abstract

Background: In non-valvular atrial fibrillation (NVAF) patients with coronary artery disease (CAD), using antiplatelet drugs in addition to anticoagulants for stroke prevention may further increase the bleeding risk. Several guidelines have recommended an oral anticoagulant (OAC) monotherapy in patients with stable CAD one year after percutaneous coronary intervention (PCI). When considering early neointima healing of current 3rd generation drug-eluting stents (DESs), the duration of the de-escalation from a single antiplatelet drug plus an OAC to an OAC alone therapy can be shortened by less than one year after PCI. The data on the clinical acceptability of short durations for de-escalation to an edoxaban monotherapy in those patients are still lacking. Methods: A multicenter, prospective, randomized, open-label, parallel group study has been established to investigate the safety outcomes of an edoxaban monotherapy in NVAF patients with stable CAD for over at least 6 months after PCI (PRAEDO AF study). From 7 institutions in Japan, approximately 200 participants will be randomized to receive either edoxaban monotherapy or edoxaban plus clopidogrel. All patients will be followed-up at least 1 year after enrollment. The primary endpoint is the percentage of serious bleeding complications and clinically significant bleeding combined events according to the ISTH criteria for edoxaban alone and edoxaban plus an antiplatelet agent. Conclusions: This will be the first study to assess the safety of edoxaban monotherapy in NVAF patients with stable CAD over 6 months after the 3rd generation DES and over 12 months after 1st or 2nd DES implantations.