Efficacy and Feasibility of Edoxaban Therapy without Prior Parenteral Anticoagulants In Patients with Venous Thromboembolism

To the Editor Edoxaban is recommended for concurrent administration with prior parenteral anticoagulants in patients diagnosed with venous thromboembolism (VTE).However, the application of pretreatment may not occur invariably in real-world clinical settings.Ueno et al. demonstrated that the efficacy and feasibility of edoxaban treatment for VTE were not significantly different irrespective of prior parenteral anticoagulant use (1).They suggested the potential viability of edoxaban therapy without pre-treatment for VTE management.However, several concerns have been raised in that regard.A notable advantage of prior parenteral anticoagulants is their prompt onset of action.Similarly, other direct oral anticoagulants recommend an escalated initial dosage for similar reasons.Parenteral anticoagulation is crucial to address the problem of massive pulmonary embolism (2).Did the authors track the trajectory of the thrombus volume during edoxaban therapy?Previous studies have indicated a higher incidence of major bleeding subsequent to pulmonary embolism in patients with active cancer than in their counterparts (3).Could the authors elaborate on why the presence of active cancer does not exert a prognostic impact on the primary outcome, specifically major bleeding (1)?The study exclusively included individuals with VTE who received edoxaban (1), thereby presenting a pivotal degree of selection bias.Consequently, these findings cannot be extrapolated to the entire VTE cohort.For instance, clinicians typically opt for parenteral anticoagulants rather than direct edoxaban therapy in patients with massive pulmonary embolism characterized by hemodynamic deterioration necessitating mechanical circulatory support.These findings may be more relevant to a less-sick VTE cohort.