Warfarin has been a highly prevalent agent for over 70 years; however, its use has been limited by drug-drug interactions, adverse events, and the need for frequent monitoring. To minimize these complications, several non-vitamin K oral anticoagulants have been approved, including the latest agent, edoxaban. Edoxaban is a factor Xa inhibitor approved for the prevention of stroke/systemic embolism in patients with non-valvular atrial fibrillation and for the treatment of venous thromboembolism. Edoxaban was largely studied in the Edoxaban versus Warfarin in Patients with Atrial Fibrillation (ENGAGE AF-TIMI 48) and Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism (Hokusai-VTE) trials, both showing noninferiority when compared with warfarin. Similar to other oral anticoagulants, the most serious adverse effects of edoxaban are related to bleeding. However, there are currently no approved reversal agents. Andexanet alfa and ciraparantag are the latest agents being studied for reversal. This article provides an overview of the safety and efficacy along with the advantages and disadvantages of edoxaban.

We present a rare case of Actinomyces turicensis bacteremia secondary to a polymicrobial sacral decubitus ulcer infection in an elderly male patient. A PubMed search revealed only 9 previously reported cases of bacteremia due to A. turicensis, mostly in female patients. Because Actinomyces species are commensal organisms of the gastrointestinal tract, sacral decubitus ulcers may have an increased propensity of becoming infected and consequently cause a bacteremia. Our patient was successfully treated with debridement and intravenous antibiotic therapy; however, the optimal antibiotic treatment and length of therapy remain unclear because only a few case reports exist in the literature.