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.
