For the past several decades, warfarin has been the go-to anticoagulant (blood thinner) for doctors, but new treatments have recently emerged in the form of direct oral anticoagulants (DOACs). This new class of anticoagulants include apixaban, betrixaban, dabigatran, edoxaban, and rivaroxaban.
NATF is dedicated to offering readers a closer look at each DOAC in order to empower patients to make informed healthcare decisions. In this issue of The Beat, NATF takes a closer look at edoxaban:
What is it?
Edoxaban, also known as Savaysa, is a blood-thinning medication used to treat or prevent blood clots from forming. It is prescribed to patients with atrial fibrillation to reduce their risk of developing stroke caused by blood clots. It is also used to treat patients with deep vein thrombosis (DVT) and pulmonary embolism (PE).
“Edoxaban is one of the new classes of blood thinners. Unlike warfarin, which has been the standard blood thinner for over half a century, edoxaban is one of the approved new agents to treat patients who either had a clot or are at risk for having a clot,” explained Dr. Christian T. Ruff, an associate physician in the Cardiovascular Division at Brigham and Women’s Hospital in Boston, MA.
How does it work?
Edoxaban is a factor Xa inhibitor, which means it blocks factor Xa in the clotting cascade.
“It works by targeting a specific protein in the clotting cascade, which is how your body forms clots,” explained Dr. Ruff. “The clotting cascade can be both good or bad. In cases of atrial fibrillation or venous thromboembolism (VTE or blood clots), we want to limit the body’s ability to form dangerous clots. Edoxaban is a factor Xa inhibitor and it inhibits a very specific clotting factor to help thin the blood.”
By blocking the factor Xa, the clotting cascade is stopped and blood is not able to form the clot.
What is unique about edoxaban?
Each blood thinner has something that makes it unique and best suited for different patients.
“If you compare edoxaban to the other new agents, there are a couple of important advantages,” said Dr. Ruff. “Edoxaban has very good efficacy, similar to the other agents, but it is one of the safest of the new blood thinners with respect to major bleeding. In its pivotal trial in atrial fibrillation, it had substantially less major bleeding than warfarin. It’s one of the safest blood thinners that we have available.”
“The other nice aspect is that it has a very well-tested dose scheme,” Dr. Ruff explained. The recommended dose is 60 mg once daily, but this can be adjusted to 30 mg daily for patients who have impaired kidney function or low body weight to prevent an excess in bleeding. “We know that patients require different dosages in order to get just the right amount of blood thinner, not too much or too little. The dosing strategy as tested in the pivotal clinical trial appears to both protect patients from stroke and lower their risk of serious bleeding.”
Edoxaban is a medication that is taken once daily. For patients who have trouble taking their medication or who just prefer to only take medication once a day, this can be a major benefit.
What are the risks?
As with all blood thinners, patients on edoxaban must be aware of their increased risk for bleeding.
“We know that the only risk for edoxaban, the only safety risk, which is true for all of the blood thinners, is that it does increase your risk of bleeding,” explained Dr. Ruff. “But, there are no other major side effects of the medication and that has been tested in tens of thousands of patients.”
Dr. Ruff stressed that serious bleeding, while an important risk to know about, is fairly rare.
“The risk of serious bleeding with these medications is incredibly uncommon. At least 50% less than what we saw with warfarin,” he said. “We have to remind patients that because these drugs work by preventing clotting, it will increase their risk of nuisance bleeding, such as minor bruising or nose bleeds, and that these are not reasons to discontinue the medication.”
Patients can help manage their bleeding risk by avoiding risky behaviors, such contact sports and drinking an excess of alcohol. They should also avoid certain other drugs, such as aspirin or NSAIDs, which also increase the risk of bleeding, unless recommend by their physician.
In addition to managing their risk of bleeding, patients need to properly manage their medication in order to avoid a new blood clot. Patients on edoxaban, or any blood thinner, should never stop their medication or change their dosage without talking to their doctor first.
“If you miss even one or two doses of this medication, you are at risk for forming a clot,” emphasized Dr. Ruff.
If you believe that edoxaban may be a good fit for you, talk to your healthcare provider about your options. NATF’s Anticoagulation Comparison Chart is a great tool that you can use with your healthcare provider to discuss which anticoagulant is right for you.