Edoxaban: A Comprehensive Review of the Pharmacology and Clinical Data for the Management of Atrial Fibrillation and Venous Thromboembolism

Abstract

Historically, vitamin K antagonists have been the only class of oral anticoagulants available. Despite our experience with warfarin over the past 60 years, its use is associated with several pharmacokinetic and clinical disadvantages including unpredictable dosing, frequent monitoring, and delayed onset and offset. Edoxaban, an oral direct Xa inhibitor, may provide clinicians with an additional option in patients requiring chronic anticoagulation. This review examines the pharmacology and clinical data of edoxaban as a therapeutic alternative.

Enhanced procoagulant activity of platelets after chemotherapy in non-small cell lung cancer

“…FXa combined with FVa stimulates prothrombin into thrombin which activates fibrinogen and finally forms fibrin. 24 Thus increased FXa contributes to more fibrin leading to rapid clotting formation and thus the coagulation time shortens. Therefore platelets after chemotherapy may contribute to the reduced clotting time and increased TAT of NSCLC patients.…”

Pharmacological Review of Anticoagulants

“…The remaining 50% of the drug is excreted renally. It has a half-life of 10-14 hours [15,19,28] (see Table 1).…”

“…Edoxaban is approved both for SSE prevention in patients with non-valvular AF and VTE treatment. In the Edoxaban versus Warfarin in Patients with Atrial Fibrillation (ENGAGE AF-TIMI 48) trial, edoxaban has shown to be non-inferior to warfarin for SSE prevention [28] (see Table 2). However, a separate analysis that was published shows that at CrCl of >95 ml/min, edoxaban is not as protective as warfarin against SSE.…”

“…Edoxaban comes in 30 and 60 mg doses. The 30 mg dose is used if patients have CrCL of 30-50 ml/min, weighs ≤60 kg, or is on verapamil, quinidine, or dronedarone (medication that are strong P-gp inhibitors) [28].…”

“…Similar to rivaroxaban and apixaban, PT/INR has low sensitivity towards edoxaban's pharmacodynamic effect and is therefore not a good laboratory test to check on the presence of the drug. Anti-factor Xa assay calibrated to edoxaban remains to be the most sensitive test for edoxaban so far [20,21,28].…”