Direct Factor Xa Inhibitor (DOAC) Pregnancy: Avoid — use LMWH in pregnancy.

Edoxaban (AF Stroke Prevention / VTE)

Brand names: Lixiana, Savaysa (US)

Adult dose

Dose: AF stroke prevention: 60 mg once daily (standard); 30 mg once daily if eGFR 15–50 mL/min, weight ≤60 kg, or concurrent verapamil/quinidine/dronedarone. VTE treatment: 60 mg once daily after ≥5 days LMWH

Route: Oral

Frequency: Once daily

Max: 60 mg/day

Once-daily DOAC — simplest dosing regimen (adherence advantage in elderly). Paradoxically LESS effective in patients with normal renal function (eGFR >95 mL/min) for AF — FDA label warns against use in this subgroup. ENGAGE-AF shows superiority over warfarin. No antidote licensed in UK (andexanet alfa licensed for rivaroxaban/apixaban — off-label for edoxaban).

Paediatric dose

Route:

Not licensed in paediatrics.

Dose adjustments

Renal

eGFR 15–50 mL/min: reduce to 30 mg once daily. eGFR <15: avoid. Very high eGFR (>95 mL/min in AF): paradoxically less effective — consider alternative DOAC.

Hepatic

Avoid in moderate-severe hepatic impairment.

Clinical pearls

ENGAGE-AF TIMI 48 (Giugliano et al. NEJM 2013): edoxaban 60 mg vs warfarin in AF — non-inferior for stroke prevention; significantly less major bleeding (20% RRR) and less cardiovascular death; less haemorrhagic stroke. High-dose edoxaban showed superior net clinical outcome
Once-daily advantage in elderly: medication adherence declines with twice-daily regimens; once-daily edoxaban (and rivaroxaban) may offer adherence advantage in elderly patients with multiple comorbidities. NICE NG196 lists edoxaban as one of four recommended DOACs for AF
Geriatric dose reduction criteria (30 mg dose): body weight ≤60 kg OR eGFR 15–50 mL/min OR concomitant P-gp inhibitor. Only one criterion needed — elderly patients frequently meet weight or renal criteria

Contraindications

Active major bleeding
eGFR <15 mL/min
Moderate-severe hepatic impairment
Antiphospholipid syndrome
Prosthetic heart valves

Side effects

Major bleeding (similar to warfarin in ENGAGE-AF — less ICH, more GI bleeding)
Anaemia
Rash
Elevated LFTs (mild, usually transient)

Interactions

Rifampicin (strong P-gp inducer — reduce to 30 mg once daily or avoid)
Verapamil, quinidine, dronedarone (P-gp inhibitors — reduce edoxaban dose to 30 mg once daily)
Ciclosporin (P-gp inhibitor — reduce dose)

Monitoring

eGFR annually (or with clinical deterioration) — dose adjustment criterion
LFTs at baseline
Body weight (dose reduction criterion ≤60 kg)
Bleeding signs
HAS-BLED score for bleeding risk stratification

Reference: BNFc; BNF 90; ENGAGE-AF TIMI 48 (Giugliano et al. NEJM 2013); NICE NG196 (AF); MHRA SPC Lixiana; NICE NG185 (VTE). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Same class

Drugs

Andexanet AlfaRecommended
Factor Xa Reversal Agent