UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Edoxaban, a new Xa inhibitor

Keywords: oral anticoagulant,edoxaban,atrial fibrillation,stroke,Xa (PubMed Search)

Posted: 12/5/2013 by Ellen Lemkin, MD, PharmD
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It has linear, predictable pharmacokinetics, achieves maximal concentration within 1-2 hours, is 50% renally excreted, and has a half life is 9-11 hours.

Edoxaban was evaluated in a recent trial comparing warfarin in patients with atrial fibrillation.

The primary end point or first stroke or systemic pulmonary embolic event occurred in 1.5% with warfarin, compared with 1.18% in the high dose edoxaban (HR 0.79; 97.5% CI 0.63-0.99, P<0.001). In the intention to treat there were trends favoring high dose edoxaban and unfavorable trends with the lower dose.

The principal safety end point of major bleeding occurred in 3.43% with warfarin versus 2.75% with high dose edoxaban (HR 0.86; 95% CI 0.71-0.91, P<0.001). 

Bottom line: Both high dose (60 mg) and low dose (30 mg) edoxaban were non-inferior to warfarin with prevention of stroke or systemic emboli, and were associated with significantly lower rates of bleeding and death from cardiovascular causes.

Currently it is approved for use in Japan.


Edoxaban versus Warfarin in Patients with Atrial Fibrillation. Giuliano, RP et al. NEJM Nov 28, 2013; 369(22):2093-2104.