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

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Objective:

To evaluate whether dual antithrombotic therapy with a direct factor Xa inhibitor and prasugrel or ticagrelor reduces ischemic events without increasing bleeding compared to standard triple therapy in patients with atrial fibrillation and acute coronary syndrome undergoing PCI.

Approach:
  • Study Design: The EPIDAURUS trial was a randomized controlled study assessing the efficacy and safety of dual antithrombotic therapy in patients with AF and ACS undergoing PCI.
  • Patient Population: The study evaluated 3,337 patients, with 602 ultimately entering the trial, which was stopped prematurely based on recommendations from the Data and Safety Monitoring Board due to compliance concerns and safety issues.
Key Findings:
  • The trial was halted due to a low probability of the experimental intervention demonstrating superiority and safety concerns, including higher rates of deaths, ischemic strokes, and bleeding events in the experimental group compared to the control group.
  • The median age of participants was 78 years, with a CHA2DS2-VA score of 4 indicating a moderate stroke risk and a HAS-BLED score of 3 indicating a moderate bleeding risk.
Interpretation:

The findings suggest that dual antithrombotic therapy may not provide the anticipated benefits in reducing ischemic events without increasing bleeding risks in this patient population. The higher incidence of adverse events in the experimental group raises concerns about the safety of this treatment strategy.

Limitations:
  • The trial was stopped early, limiting the ability to draw definitive conclusions.
  • Protocol deviations were more frequent in the experimental group, raising compliance concerns that may have affected the outcomes.
Conclusion:

The EPIDAURUS trial underscores the need for caution when considering dual antithrombotic therapy in patients with atrial fibrillation and acute coronary syndrome. The increased risk of adverse events highlights the importance of balancing efficacy and safety in antithrombotic treatment strategies.

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

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