Edoxaban (VTE Treatment/PE — Vascular)

How it works

Edoxaban is an oral direct, reversible inhibitor of activated factor Xa, reducing thrombin generation and fibrin clot formation within the coagulation cascade.

Prescribing in practice

• For venous thromboembolism it must be preceded by initial parenteral anticoagulation for several days, and bleeding is the main risk so renal function and concomitant antithrombotics need review.
• It is partly renally cleared and a P-glycoprotein substrate, so dose reduction applies in moderate renal impairment, low body weight or with certain P-glycoprotein inhibitors.
• Reduced efficacy has been observed at higher levels of renal function in atrial fibrillation, and it should be avoided in severe hepatic impairment.

Monitoring

Assess renal and hepatic function before starting and periodically thereafter, and review clinically for bleeding rather than performing routine coagulation monitoring.

Counselling the patient

• For a clot, a few days of injectable anticoagulant come first, then once-daily tablets.
• Report unusual or prolonged bleeding promptly.
• Take it at the same time each day and carry an anticoagulant alert card.

Evidence & guidelines

The Hokusai-VTE trial showed edoxaban after initial heparin was non-inferior to warfarin for treating venous thromboembolism with less major bleeding, supporting its NICE-approved use.