Clinical Pharmacology and Role of Edoxaban in Contemporary Antithrombotic Therapy

Edoxaban is a factor Xa inhibitor that is approved for prevention of stroke in individuals with atrial fibrillation and treatment of venous thromboembolic disease at once daily 60 mg dose for individuals with normal renal function. A decrease of dose to 30 mg is recommended for those with moderate renal insufficiency, weight ≤ 60 kg or simultaneous administration of strong P-glycoprotein inhibitors. At this time, it is not recommended for use in persons with either end stage renal disease or with GFR exceeding 95 mL/min. Shorter half-life averaging 8-10 hours may translate into a safer profile. With a fast onset of action of ~1.5 hours and relatively high bioavailability, edoxaban is an alternative for patients who may not be good candidates for warfarin therapy due to multiple limitations that vitamin K anticoagulation entails. No clear benefits of edoxaban have been reported to date compared to the other available factor Xa inhibitors.