Edoxaban

Administration

• Type: Anticoagulant
• Dosage Forms: 15, 30, 60 mg
• Routes of Administration: Oral
• Common Trade Names: Savaysa

Adult Dosing

Thromboembolism/stroke Prophylaxis

• 60 mg PO qd

DVT/PE Treatment

• <60 kg
  • 30 mg PO qd
• >60 kg
  • 60 mg PO qd

Pediatric Dosing

N/A

Special Populations

• Pregnancy Rating: D; Avoid use (Risk of maternal hemorrhage and embryo-fetal death up to 49xMRHD based on animal data and risk of maternal/fetal bleeding base don mechanism of action; No known risk of teratogenicity)
• Lactation risk: L3; Safety unknown

Renal Dosing

• Adult:
  • Thromboembolism/stroke Prophylaxis
    • CrCl > 95: Avoid Use
    • CrCl 50-95: No Adjustment
    • CrCl 15-50: 30 mg qd
    • CrCl <15 (not on HD): Avoid use
  • DVT/PE treatment
    • CrCl 15-30: 30 mg qd
    • Cr Cl <15 (not on HD): Avoid use
• Pediatric: N/A

Hepatic Dosing

• Adult: Child-Pugh Class B or C: Avoid use
• Pediatric: N/A

Contraindications

• Allergy to class/drug
• Hypersenstivity to drug/class/component
• Active major bleeding
• CrCl > 95 (non-valvular atrial fibrillation patients)
• CrCl < 15
• Hepatic impairment (Child-Pugh Class B or C)

Adverse Reactions

Serious

• Epidural hematoma
• Bleeding, severe
• Thrombosis with premature D/C

Common

• Bleeding
• Anemia
• Rash
• ALT, AST elevation

Pharmacology

• Half-life: 10-14 hr
• Metabolism: Minimal; CYP450: 3A4 substrate
• Excretion: Urine 50%

Mechanism of Action

Factor Xa inhibitor

Comments

• Black Box Warnings:
  • Reduced Efficacy in non-valvular Afib Pts w/ CrCl >95mL/min with increased risk for ischemic stroke
  • Premature treatment discontinuation increases the risk of increased ischemic event for reasons other than pathological bleeding or course completion
  • Epidural/Spinal Hematoma Risk after anesthesia or spinal puncture may result in long-term or permanent paralysis and increases.

See Also

• Anticoagulant reversal for life-threatening bleeds

References

Authors

Jonathan Warren, Claire, Ross Donaldson, Daniel Ostermayer