Makindo Medical Notes

Edoxaban is indicated in non-rheumatic AF when risk factors are present (previous stroke/TIA, CCF, age >75 years, diabetes, or hypertension). Also used in treatment of DVT/PE. Always balance risk vs benefit and check renal function.

📖 About

• 💊 A DOAC (direct oral anticoagulant).
• Convenient once-daily dosing.
• BNF link here for latest updates.

⚙️ Mode of Action

• Direct, selective and reversible factor Xa inhibitor.
• Prevents conversion of prothrombin → thrombin → fibrin clot.
• Does not require antithrombin as a cofactor (unlike heparins).

💊 Indications & Dose

• DVT / PE (treatment): - Start Edoxaban 60 mg OD after 5 days LMWH. - Reduce to 30 mg OD if weight <60 kg, or with certain interacting drugs.
• Non-rheumatic AF (stroke prevention): - 60 mg OD (or 30 mg OD if weight <60 kg).
• VTE prevention: ❌ Not licensed.

🔄 Interactions

• Reduce dose to 30 mg OD if co-prescribed with: - Ciclosporin, dronedarone, erythromycin, ketoconazole.
• ⚠️ Caution with other anticoagulants / antiplatelets (↑ bleeding risk).

⚠️ Cautions

• High bleeding risk (HAS-BLED score, uncontrolled hypertension).
• Liver disease or baseline coagulopathy.
• Renal function must be monitored (dose adjustment if impaired).

⛔ Contraindications

• Severe renal impairment (CrCl <15 mL/min).
• Active pathological bleeding.
• GI ulcers, oesophageal varices, vascular aneurysm.
• Recent brain, spinal or ophthalmic surgery.
• Recent intracranial haemorrhage, malignant neoplasms at risk of bleeding.
• Severe hypersensitivity reactions to the drug.

🤒 Side Effects

• Bleeding (GI, GU, intracranial).
• Skin: urticaria, rash (rare).
• Liver function abnormalities possible.

💡 Teaching Pearls

🍄 Enoki Memory Hook: "Edoxaban Ends Xa" → think direct Xa blocker.
🔑 Key exam tip: All DOACs need renal function checks (different cut-offs for rivaroxaban, apixaban, dabigatran, edoxaban).
❗ Avoid in valvular AF (rheumatic mitral stenosis, mechanical valves) — use warfarin instead.

📚 References

• BNF: Edoxaban
• ESC 2020 Guidelines on Atrial Fibrillation.
• Katzung BG. Basic & Clinical Pharmacology, 15th Ed.