Direct Factor Xa Inhibitor (DOAC) Pregnancy: Contraindicated during pregnancy and breast-feeding. Women of childbearing potential should avoid becoming pregnant during treatment.

Edoxaban (AF Stroke Prevention / VTE)

Brand names: Lixiana, Savaysa (US)

Edoxaban is a direct oral anticoagulant (a factor Xa inhibitor) used for stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 60 mg once daily; reduce to 30 mg once daily if any of: moderate or severe renal impairment (CrCl 15-50 mL/min), body weight 60 kg or less, or concomitant ciclosporin, dronedarone, erythromycin or ketoconazole

Route: Oral

Frequency: Once daily

Same 60 mg once-daily dose for prevention of stroke and systemic embolism in NVAF (continue long term) and for treatment of DVT/PE and prevention of recurrent VTE. For VTE, edoxaban follows initial use of a parenteral anticoagulant for at least 5 days — edoxaban and the initial parenteral anticoagulant must not be given simultaneously. VTE treatment duration should be individualised: at least 3 months where risk factors are transient (recent surgery, trauma, immobilisation), longer for permanent risk factors or idiopathic DVT/PE. Elderly: no dose reduction is required, but co-administration with acetylsalicylic acid in elderly patients should be used cautiously because of a potentially higher bleeding risk. Missed dose: take immediately and continue once daily the following day; do not double the dose. Switching from a VKA: discontinue the VKA and start edoxaban when INR is 2.5 or below; from unfractionated heparin infusion: stop the infusion and start edoxaban 4 hours later. The 15 mg strength is not indicated as monotherapy — it is only for switching from edoxaban 30 mg to a VKA (patients on 60 mg switch via 30 mg once daily with an appropriate VKA dose). Hepatic impairment: not recommended in severe hepatic impairment. No specific reversal agent is available and haemodialysis does not significantly contribute to edoxaban clearance.

Dose adjustments

Renal

Assess CrCl (Cockcroft-Gault) before starting. CrCl >50-80 mL/min: 60 mg once daily. CrCl 15-50 mL/min: 30 mg once daily. Not for use in end stage renal disease (CrCl <15 mL/min) or on dialysis. Use in NVAF with high CrCl only after careful evaluation of individual thromboembolic and bleeding risk (US label: do not use if CrCl >95 mL/min). Reassess renal function when a change is suspected.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

Treatment of NVAF: Assess CrCL before initiating therapy ( 2.1 ) The recommended dose is 60 mg once daily in patients with CrCL >50 to ≤ 95 mL/min. Do not use SAVAYSA in patients with CrCL > 95 mL/min ( 2.1 ) Reduce dose to 30 mg once daily in patients with creatinine clearance 15 to 50 mL/min ( 2.1 ) Treatment of DVT and PE: The recommended dose is 60 mg once daily ( 2.2 ) Reduce dose to 30 mg once daily for patients with CrCL 15 to 50 mL/min or body weight less than or equal to 60 kg or who use certain P-gp inhibitors ( 2.2 ) 2.1 Nonvalvular Atrial Fibrillation The recommended dose of SAVAYSA is 60 mg taken orally once daily [see Warnings and Precautions (5.1) and Clinical Studies (14.1) …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2025-07-10. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypersensitivity to edoxaban or any excipient
Clinically significant active bleeding
Hepatic disease associated with coagulopathy and clinically relevant bleeding risk
Lesion or condition considered a significant risk for major bleeding (e.g. current/recent GI ulceration, malignancy at high bleeding risk, recent brain/spinal injury or surgery, recent intracranial haemorrhage, oesophageal varices, arteriovenous malformations, vascular aneurysms)
Uncontrolled severe hypertension
Concomitant treatment with any other anticoagulant (UFH, LMWH, heparin derivatives, warfarin, dabigatran, rivaroxaban, apixaban), except when switching or when UFH is used to keep a central venous or arterial catheter open
Pregnancy and breast-feeding

Side effects

Epistaxis (7.7%)
Macroscopic haematuria/urethral haemorrhage (6.9%)
Anaemia (5.3%)
Upper and lower gastrointestinal haemorrhage, oral/pharyngeal haemorrhage, abdominal pain and nausea
Rash and pruritus; abnormal liver function tests (raised bilirubin, GGT)

Interactions

P-glycoprotein inhibitors — ciclosporin, dronedarone, erythromycin or ketoconazole require the reduced 30 mg once-daily dose
Other anticoagulants — contraindicated concomitantly except during defined switching
Antiplatelet drugs, aspirin, NSAIDs, thrombolytics and SSRIs/SNRIs increase bleeding risk; monitor closely
Acetylsalicylic acid in elderly patients — use cautiously (higher bleeding risk)

Clinical monograph

How it works

It directly and reversibly inhibits activated factor Xa, reducing thrombin generation and clot formation.

Prescribing in practice

Bleeding is the main risk; assess bleeding and thrombotic risk, and the dose depends on renal function and body weight.
In atrial fibrillation, efficacy may be reduced in patients with high creatinine clearance, which is a labelled caution when choosing therapy.
It is taken once daily and does not require routine anticoagulant monitoring.

Monitoring

Monitor renal function, full blood count and for signs of bleeding; reassess if renal function or weight changes.

Counselling the patient

Report unusual bruising or bleeding, black stools or blood in the urine.
Do not stop the medicine without advice, and tell other clinicians and dentists you take an anticoagulant.

Evidence & guidelines

Non-inferior to warfarin for stroke prevention in atrial fibrillation (ENGAGE AF-TIMI 48) and recommended in UK guidance (NICE NG196).

Reference: ENGAGE-AF TIMI 48 (Giugliano et al. NEJM 2013); NICE NG196 (AF); MHRA SPC Lixiana; NICE NG185 (VTE); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Same class

Drugs

Andexanet AlfaRecommended
Factor Xa Reversal Agent