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

Potent P2Y12 inhibitors combined with DOACs increase bleeding risk without reducing ischemic events in atrial fibrillation and acute coronary syndrome patients.

• Why it matters: Optimizing antithrombotic therapy in these patients is critical to balance bleeding and ischemic risks, yet current evidence is inconclusive and safety concerns persist.
• What they did: An open-label, randomized controlled trial (EPIDAURUS) enrolled 602 patients to compare 1-month regimens of DOAC plus potent P2Y12 inhibitors (prasugrel or ticagrelor) versus DOAC plus clopidogrel and aspirin, assessing ischemic and bleeding outcomes.
• The result: The trial was halted early due to safety issues, revealing higher bleeding rates with potent P2Y12 inhibitors without clear ischemic benefit, suggesting these drugs should not be routinely combined with DOACs in this setting.