Efficacy of 15 mg Edoxaban on Long-Term Outcome after Percutaneous Coronary Intervention in Patients with Atrial Fibrillation and High Bleeding Risk

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In patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI), dual antiplatelet therapy (DAPT) plus oral anticoagulants increase bleeding risk. Low-dose edoxaban (15 mg) is safe for high-risk older patients with AF; however, its role after PCI compared with the standard 30 mg dose remains unclear. We aimed to compare outcomes of 15 mg and 30 mg edoxaban after PCI.We retrospectively analyzed data from patients with AF undergoing PCI for acute coronary syndrome who received edoxaban 30 mg (n = 99) or 15 mg (n = 49). During admission, DAPT was transitioned to P2Y12 inhibitor monotherapy. Bleeding and thrombotic events were assessed over 2 years, alongside CHADS2, HAS-BLED, and CREDO-Kyoto scores.Compared with 30 mg edoxaban, patients on 15 mg edoxaban were older (86 ± 2 versus 80 ± 6 years, P< 0.01) and had lower hemoglobin levels and body mass index (19.4 ± 3.1 versus 22.7 ± 2.7, P < 0.01) but higher CHADS2 (3.3 ± 0.9 versus 2.8 ± 0.9, P < 0.01), HAS-BLED (3.2 ± 0.9 versus 2.6 ± 0.6, P < 0.01), and CREDO-Kyoto thrombotic and bleeding (5.0 ± 1.1 versus 4.0 ± 1.8, P < 0.01; and 4.1 ± 1.7 versus 2.7 ± 1.2, P < 0.01, respectively) scores. Major bleeding, including clinically relevant non-major bleeding, was more frequent in the 30 mg group (19.7% versus 6.8%, P = 0.08); thrombotic events were comparable (7.4% versus 3.0%, P = 0.35).In weighted Cox analysis, 15 mg edoxaban showed numerically lower hazard ratios for thrombotic (HR: 0.12, 95% CI: 0.01-1.17; P = 0.09) and bleeding (HR: 0.24, 95% CI: 0.06-1.29; P = 0.07) events compared with 30 mg, although these differences did not reach statistical significance.Among older high bleeding-risk patients with AF undergoing PCI, 15 mg edoxaban did not demonstrate superiority over 30 mg with respect to thrombotic or bleeding outcomes.

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