Dual antithrombotic therapy using potent antiplatelet inhibitors in atrial fibrillation and acute coronary syndrome: a randomized controlled trial - Report - MDSpire
Coming Soon: Introducing MDSpire News. Learn more
Conexiant’s news site is now MDSpire News. Learn more

Evaluating the Efficacy of Combined Antithrombotic Treatment with Strong Antiplatelet Agents in Patients with Atrial Fibrillation and Acute Coronary Syndrome: A Randomized Controlled Study

  • By

  • Konstantinos D. Rizas

  • Konstantinos Mourouzis

  • Dominik Rath

  • Christoph B. Olivier

  • Laura Elisa Villegas Sierra

  • Theofanis Korovesis

  • Amin Polzin

  • Amani Al Tawil

  • Reza Wakili

  • Lukas von Stuelpnagel

  • Katharina Mayer

  • Marion Janisch

  • Tanja Ulrich

  • Sarah Lang

  • Sebastian K. G. Maier

  • Florian Brattinger

  • Lorenz Bott-Flügel

  • Harilaos Bogossian

  • Konstantinos Iliodromitis

  • Luisa Freyer

  • Julius Steffen

  • Konstantin Stark

  • Elodie Eiffener

  • Lauren E. Sams

  • Tobias Petzold

  • Axel Linke

  • Felix M. Heidrich

  • Samuel Sossala

  • Saif Zako

  • Nikolaos Dagkonakis

  • Andreas Schäfer

  • Frank Edelmann

  • David M. Leistner

  • Mariya Maslarska

  • Fabian Knebel

  • Georg Nickenig

  • Blerim Luani

  • Tienush Rassaf

  • Hüseyin Ince

  • Ibrahim Akin

  • Micha T. Maeder

  • Meinrad Gawaz

  • Hans-Josef Feistritzer

  • Norbert Frey

  • Stefan Kääb

  • Riza Sahin

  • Matthias Pauschinger

  • Thomas Stiermaier

  • Ingo Eitel

  • Marc Kollum

  • Jan Sebastian Wolter

  • Michael Schreinlechner

  • Axel Bauer

  • Christoph Stellbrink

  • Ulf Landmesser

  • Paulus Kirchhof

  • Dirk Sibbing

  • Holger Thiele

  • Adnan Kastrati

  • Ulrich Mansmann

  • Steffen Massberg

  • August 29, 2026

Share

Clinical Report: Efficacy of Combined Antithrombotic Treatment in AF and ACS

Overview

The EPIDAURUS trial evaluated dual antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome undergoing PCI. The trial was halted due to safety concerns, with the Data and Safety Monitoring Board reporting a higher incidence of deaths, ischemic strokes, and bleeding events in the experimental group compared to standard therapy.

Background

Optimal antithrombotic management for patients with atrial fibrillation (AF) and acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) is challenging due to the need to balance ischemic-event prevention with bleeding risk. Current strategies, including triple antithrombotic therapy, have been associated with increased bleeding complications.

Data Highlights

The trial was halted prematurely, resulting in no numerical data available from the trial results.

Key Findings

  • The EPIDAURUS trial was stopped prematurely due to safety concerns raised by the Data and Safety Monitoring Board.
  • Higher numbers of deaths, ischemic strokes, and bleeding events were observed in the experimental group compared to the control group.
  • 602 patients were enrolled in the trial, with 302 randomized to the experimental group and 300 to the control group.
  • The trial aimed to evaluate dual antithrombotic therapy with a direct factor Xa inhibitor and prasugrel or ticagrelor.
  • Previous studies indicated that potent P2Y12 inhibitors like ticagrelor or prasugrel may improve outcomes compared to clopidogrel.

Clinical Implications

The premature termination of the EPIDAURUS trial highlights the need for careful consideration of safety in clinical trials involving antithrombotic therapies.

Conclusion

The findings from the EPIDAURUS trial indicate the necessity for further research to establish safe and effective antithrombotic strategies for patients with atrial fibrillation and acute coronary syndrome.

Related Resources & Content

  1. MDSpire News, 2023 -- Dual Therapy for Coronary Disease: How Safe Is It?
  2. Clinical Research in Cardiology, 2020 -- Antithrombotic Approaches for Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention
  3. Frontiers in Cardiovascular Medicine, 2026 -- Efficacy and safety of different antithrombotic treatment regimens in patients undergoing transcatheter mitral valve repair and atrial fibrillation; A meta-analysis and systematic review
  4. 2025 Guideline for Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
  5. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation | New England Journal of Medicine
  6. 2026 AHA/ACC Clinical Performance and Quality Measures for Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association
  7. Frontiers in Cardiovascular Medicine — Long-term single antiplatelet therapy for patients with acute coronary syndrome at high-risk for ischemia and bleeding: a precision cohort study
  8. 2025 Guideline for Acute Coronary Syndromes - Professional Heart Daily | American Heart Association
  9. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation | New England Journal of Medicine
  10. 2026 AHA/ACC Clinical Performance and Quality Measures for Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association | JACC

Original Source(s)

Dual antithrombotic therapy using potent antiplatelet inhibitors in atrial fibrillation and acute coronary syndrome: a randomized controlled trial

  • by Konstantinos D. Rizas, Konstantinos Mourouzis, Dominik Rath, Christoph B. Olivier, Laura Elisa Villegas Sierra, Theofanis Korovesis, Amin Polzin, Amani Al Tawil, Reza Wakili, Lukas von Stuelpnagel, Katharina Mayer, Marion Janisch, Tanja Ulrich, Sarah Lang, Sebastian K. G. Maier, Florian Brattinger, Lorenz Bott-Flügel, Harilaos Bogossian, Konstantinos Iliodromitis, Luisa Freyer, Julius Steffen, Konstantin Stark, Elodie Eiffener, Lauren E. Sams, Tobias Petzold, Axel Linke, Felix M. Heidrich, Samuel Sossala, Saif Zako, Nikolaos Dagkonakis, Andreas Schäfer, Frank Edelmann, David M. Leistner, Mariya Maslarska, Fabian Knebel, Georg Nickenig, Blerim Luani, Tienush Rassaf, Hüseyin Ince, Ibrahim Akin, Micha T. Maeder, Meinrad Gawaz, Hans-Josef Feistritzer, Norbert Frey, Stefan Kääb, Riza Sahin, Matthias Pauschinger, Thomas Stiermaier, Ingo Eitel, Marc Kollum, Jan Sebastian Wolter, Michael Schreinlechner, Axel Bauer, Christoph Stellbrink, Ulf Landmesser, Paulus Kirchhof, Dirk Sibbing, Holger Thiele, Adnan Kastrati, Ulrich Mansmann, Steffen Massberg

  • August 29, 2026

Related Content

Trends and disparities in deaths involving atherosclerotic cardiovascular disease and stroke-related conditions among U.S. adults, 1999–2025

Cerebral hemorrhage after left ventricular assist device implantation in a patient with dilated cardiomyopathy: a case report

Tirzepatide’s cardiovascular effects in clinical practice

Investigators compared cardiovascular outcomes with tirzepatide and a placebo proxy in patients with type 2 diabetes and established atherosclerotic cardiovascular disease.