What is Lixiana (edoxaban)?

From the Guidelines

Lixiana (edoxaban) is recommended as a direct oral anticoagulant (DOAC) for patients with atrial fibrillation, with a typical dose of 60 mg once daily, and a reduced dose of 30 mg daily for patients with moderate to severe kidney impairment, low body weight (≤60 kg), or those taking certain P-glycoprotein inhibitors, as it has been shown to be noninferior to warfarin in preventing stroke or systemic embolization and is associated with significantly lower rates of bleeding and death from cardiovascular causes 1. The decision to use Lixiana should be based on an assessment of the risks of stroke and bleeding, and patients should be closely monitored for any signs of bleeding or bruising. Some key points to consider when prescribing Lixiana include:

• The dose of 60 mg once daily is recommended for most patients, but a reduced dose of 30 mg daily may be necessary for certain patients, such as those with kidney impairment or low body weight 1.
• Lixiana works by inhibiting Factor Xa, a key enzyme in the blood clotting cascade, thereby preventing thrombus formation.
• Unlike warfarin, Lixiana does not require regular blood monitoring and has fewer food and drug interactions, making it more convenient for many patients.
• However, Lixiana still carries bleeding risks, and patients should report any unusual bleeding or bruising to their healthcare provider immediately.
• Lixiana should be taken at the same time each day with or without food, and patients should not stop taking it without consulting their doctor as this could increase stroke risk. In terms of specific patient populations, the following should be considered:
• Patients with atrial fibrillation: Lixiana is recommended for stroke prevention in patients with non-valvular atrial fibrillation, with a dose of 60 mg once daily, and a reduced dose of 30 mg daily for patients with moderate to severe kidney impairment, low body weight (≤60 kg), or those taking certain P-glycoprotein inhibitors 1.
• Patients with venous thromboembolism (VTE): Lixiana is recommended for the treatment and prevention of VTE, with a dose of 60 mg once daily, and a reduced dose of 30 mg daily for patients with moderate to severe kidney impairment, low body weight (≤60 kg), or those taking certain P-glycoprotein inhibitors 1.

From the Research

Lixiana (Edoxaban) Overview

• Lixiana, also known as edoxaban, is a direct oral anticoagulant that selectively inhibits factor Xa coagulation factor 2.
• It is used for the prevention of stroke and systemic embolic events in patients with nonvalvular atrial fibrillation and one or more risk factors 3.
• Edoxaban has been shown to be noninferior to warfarin in terms of efficacy and has a lower risk of major bleeding, including intracranial hemorrhage, and death from cardiovascular causes 3, 2.

Clinical Trials and Studies

• The ENGAGE AF-TIMI 48 trial demonstrated that edoxaban 60 mg once daily was noninferior to warfarin for the prevention of stroke or systemic embolism in patients with nonvalvular atrial fibrillation 3, 2, 4.
• The Hokusai-VTE trial evaluated the use of edoxaban for the treatment and secondary prevention of deep venous thrombosis and pulmonary embolism 2.
• A review of the current evidence on edoxaban in patients with nonvalvular atrial fibrillation confirmed its non-inferiority compared to well-managed warfarin in terms of efficacy and safety 5.

Dosage and Administration

• Edoxaban is prescribed at a dose of 60 mg once daily, which should be reduced to 30 mg once daily in patients with renal impairment, a body weight below or equal to 60 kg, and/or concomitant therapy with some strong P-glycoprotein inhibitors 2.
• It offers the convenience of oral, once-daily, fixed-dose administration, without the need for coagulation monitoring and without regard to food 3.

Safety and Efficacy

• Edoxaban has been shown to be a safe and effective anticoagulant for the prevention of stroke in patients with nonvalvular atrial fibrillation and for the treatment of venous thromboembolism 6.
• The most common adverse effect of edoxaban is bleeding, similar to other anticoagulants 6.
• Edoxaban seems to be a cost-effective alternative to warfarin among patients with moderate to high thromboembolic risk 4.