edoksaban

Edoxaban is an oral direct anticoagulant that inhibits factor Xa, reducing thrombin generation and clot formation. It is sold under the brand names Savaysa in the United States and Lixiana in the European Union. As a direct oral anticoagulant (DOAC), it provides targeted anticoagulation without routine laboratory monitoring for most patients.

Medical uses include reducing the risk of stroke and systemic embolism in nonvalvular atrial fibrillation and the treatment of deep vein thrombosis and pulmonary embolism after initial parenteral anticoagulation. In atrial fibrillation, edoxaban is typically given once daily; in the treatment of DVT/PE, a short course of initial heparin is followed by edoxaban.

Dosing and renal considerations: For nonvalvular AF, the usual dose is 60 mg once daily. A 30 mg once-daily dose is used when creatinine clearance is 15–50 mL/min, body weight is 60 kg or less, or there is concomitant use of certain P‑glycoprotein inhibitors. Edoxaban is not recommended for AF patients with creatinine clearance above 95 mL/min due to lower effectiveness. For DVT/PE treatment, after 5–10 days of initial heparin, 60 mg once daily is used, with the same dose reductions applied for renal impairment or low body weight or P‑gp inhibitors.

Contraindications and cautions: It should not be used in active major bleeding. It is not indicated for mechanical heart valves and is used with caution in hepatic impairment. It is generally avoided in severe renal impairment (below 15 mL/min) and during pregnancy or lactation.

Adverse effects and safety: The most common adverse effect is bleeding, ranging from minor to major. Other risks include anemia. Routine monitoring of coagulation is not required, but anti‑Xa activity can be measured in special situations.

Interactions: Drugs that strongly inhibit or induce P‑glycoprotein can alter edoxaban levels. Rifampin is contraindicated due to induction of P‑gp and reduced edoxaban exposure.