Edoxaban: A direct oral anticoagulant

Poulakos, Mara N.; Walker, Jacqueline N.; Baig, Umima; David, Tosin

doi:10.2146/ajhp150821

Cited by 38 publications

(39 citation statements)

References 38 publications

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“…dabigatran should not be used by patients with a mechanical heart valve for antithrombotic prophylaxis (49). Several reviews and retrospective cohort studies indicated that apixaban has better effectiveness than edoxaban, rivaroxaban, and dabigatran for its shorter time to peak level and its longer half-life (6,50,51). Moreover, studies showed that apixaban was more cost-effective than warfarin, dabigatran, edoxaban, and rivaroxaban for stroke prevention in patients with AF (17,52).…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Direct Oral Anticoagulants in Elderly Patients With Atrial Fibrillation: A Network Meta-Analysis

et al. 2020

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Background: Direct oral anticoagulants (DOACs) have been widely used in patients with atrial fibrillation (AF) for antithrombotic prophylaxis, which were shown to have a favorable risk-benefit profile. However, there are no guidelines for the use of DOACs in elderly patients (aged ≥75 years) with AF, which creates uncertainty about the optimal antithrombotic treatment in these patients. Methods: After comprehensively searching Embase, PubMed, and Cochrane databases, five phase III randomized controlled trials involving 28,137 elderly participants were included in this study. The efficacy outcome was stroke or systemic embolism, and the safety outcome was major bleeding. We conducted a network meta-analysis by using a Bayesian random-effect model for the first time to evaluate the efficacy and safety of main DOACs (apixaban, edoxaban, rivaroxaban, and dabigatran) and warfarin in elderly patients with AF. Hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were used to assess the effect of drugs on efficacy and safety. The rank probabilities were used to reflect the hierarchy of drugs, and a larger rank probability value symbolized a better rank of drugs. Results: In the prophylaxis of stroke or systemic embolism, apixaban was found to be the best among DOACs compared to warfarin (HR, 0.71; 95% CI: 0.33-1.50), though this finding was not statistically significant. Apixaban ranked the best (rank probabilities, 41.2%) in efficacy of drugs, followed by rivaroxaban, edoxaban, dabigatran, and warfarin (rank probabilities, 31.8, 15.9, 10.9, and 0.2%, respectively). In reducing the risk of major bleeding, apixaban was found to be the best among DOACs too, compared to warfarin (HR, 0.64; 95% CI: 0.33-1.30), though this finding was not statistically significant. In safety, apixaban ranked the best (rank probabilities, 71.4%), followed by edoxaban, dabigatran, warfarin, and rivaroxaban (rank probabilities, 21.0, 5.8, 0.9, and 0.8%, respectively). Conclusions: DOACs showed a lower incidence of stroke/systemic embolism and major bleeding compared with warfarin in antithrombotic therapy in elderly patients (aged ≥75 years), with apixaban being the best of those interventions. Therefore, apixaban should be given priority as an anticoagulant in stroke prevention for elderly patients with AF.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of Direct Oral Anticoagulants in Elderly Patients With Atrial Fibrillation: A Network Meta-Analysis

et al. 2020

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“…After oral administration, dabigatran etexilate is rapidly hydrolyzed by non-specific, ubiquitous esterases to the active form, dabigatran [10]. Rivaroxaban (Xarelto ® ), apixaban (Eliquis ® ), and edoxaban (Savaysa ® ) are orally administered, selective, reversible FXaIs [10,11].…”

Section: What Are Doacs?mentioning

confidence: 99%

Patients Taking Direct Oral Anticoagulants (DOAC) Undergoing Oral Surgery: A Review of the Literature and a Proposal of a Peri-Operative Management Protocol

Lupi

Baena

2020

Healthcare

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Patients on anticoagulant therapy for the prevention of cardiovascular accidents present an increased risk of bleeding following dental and oral surgery. Four recently introduced non-vitamin K antagonist oral anticoagulants, namely dabigatran etexilate (direct thrombin inhibitor), rivaroxaban, apixaban, and edoxaban (Xa factor direct inhibitor), are widely spreading for convenience of use compared to the older drug class. Dental management of patients taking these drugs has substantial differences compared to patients on vitamin K antagonist therapy. Anticoagulation is not assessed directly through a hematological test, but indirectly by renal function. The interventions must be scheduled at the time of minimum blood concentration of the drug. Bleeding can occur even after several days following the surgery. The interaction with drugs administered for dental care must be carefully evaluated. The peri-operative diet can influence the risk of bleeding. Local measures favoring coagulation must be adopted. The interventions with higher risk must be divided into multiple less invasive interventions. Although antidotes exist for these drugs, their use does not seem necessary for dental interventions that have been planned optimally. Furthermore, in this review of the literature a decision protocol is proposed for the evaluation of the suspension of the anticoagulant drug before oral surgery. Cessation of any anticoagulant should only be made in consultation with the patient’s general practitioner/cardiologist, who will weigh up the risk of bleeding from the proposed procedure with the risk of thrombosis/stroke in each individual patient.

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“…Factor Xa is a protease that serves to convert prothrombin into thrombin which, in turn, converts fibrinogen into fibrin and allows for clotting. Edoxaban has a dual mechanism of action in that it inhibits both free Factor Xa and also the by-product Factor Xa produced by prothrombinase [63]. Like other NOAC medications, it requires less laboratory monitoring, has fewer drug-drug and food-drug interactions, and lowers the risk of major bleeding compared to warfarin.…”

Section: Edoxabanmentioning

confidence: 99%

“…It is not metabolized via the CYP450 enzyme system (which is the case for apixaban and rivaroxaban), and it was shown in the ENGAGE AF-TIMI study to be noninferior to warfarin. It is an oral agent that need be taken only once daily [63]. The safety and efficacy of edoxaban seem to be similar to other NOAC medications for the control of venous thromboembolism to reduce the risk of stroke in nonvalvular AF patients.…”

Section: Edoxabanmentioning

confidence: 99%

Anticoagulation in Atrial Fibrillation Patients

Magnusson¹,

Pergolizzi²,

Wolf³

et al. 2020

Epidemiology and Treatment of Atrial Fibrillation

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Atrial fibrillation (AF) is the most common arrhythmia and may cause thromboembolic events, typically stroke. Advances in pharmacological approaches to anticoagulation and groundbreaking large randomized controlled trials of non-vitamin K antagonist oral anticoagulants (NOACs) have changed the paradigm of anticoagulation therapy. Furthermore, observational studies support the efficacy and safety of NOAC. Few studies address the differences among NOACs, but prescriptions should be based on a thorough understanding of their pharmacological differences, including interactions, side effects, reversibility, and practical approach. In a subset of patients with AF, warfarin may still be the preferable option. Consequently, an individualized approach to oral anticoagulation is crucial.

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Edoxaban: A direct oral anticoagulant

Abstract: A review of the literature showed that edoxaban, the most recently approved DOAC, is noninferior to warfarin for management of VTE (after parenteral anticoagulant therapy) and for stroke risk reduction in many patients with nonvalvular AF.

Cited by 38 publications

References 38 publications

Efficacy and Safety of Direct Oral Anticoagulants in Elderly Patients With Atrial Fibrillation: A Network Meta-Analysis

Efficacy and Safety of Direct Oral Anticoagulants in Elderly Patients With Atrial Fibrillation: A Network Meta-Analysis

Patients Taking Direct Oral Anticoagulants (DOAC) Undergoing Oral Surgery: A Review of the Literature and a Proposal of a Peri-Operative Management Protocol

Anticoagulation in Atrial Fibrillation Patients

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