Edoxaban (Stroke Prevention)

How it works

It is a direct, selective inhibitor of activated factor X (factor Xa), reducing thrombin generation and clot formation.

Prescribing in practice

• The major risk is bleeding, and notably its efficacy for stroke prevention may be reduced in patients with high creatinine clearance, so renal function must guide patient selection and dosing.
• It is contraindicated in severe renal impairment and in active clinically significant bleeding, and exposure is affected by potent P-glycoprotein inhibitors.
• Assess renal and hepatic function and bleeding risk before starting; no routine coagulation monitoring is required.

Monitoring

Check renal and hepatic function before treatment and at least annually thereafter, reviewing more frequently if renal function or clinical status changes.

Counselling the patient

• Take once daily at the same time each day and do not stop without advice.
• Report unusual bleeding, black stools, bruising or significant falls.
• Carry an anticoagulant alert card and tell clinicians before procedures.

Evidence & guidelines

The ENGAGE AF-TIMI 48 trial established edoxaban as non-inferior to warfarin for stroke prevention in atrial fibrillation, supporting its NICE-recommended use.