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Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation during exposed and unexposed treatment periods
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  • Published on: 5 March 2025
    The special case for low-dose edoxaban

    Given the disparity between the number of patients in apixaban(4261 patients) and the number of patients on edoxaban(76 patients)[1] it was not possible to make a meaningful comparison between the two agents especially because, in other contexts, edoxaban has been utilised in doses ranging from 15 mg/day to 6o mg/day in people with atrial fibrillation(AF){2],{3]. Accordingly, to lump edoxaban with other direct oral anticoagulants(DOACS) in the comparison with warfarin, as Mitchell et al have done(fig 4)[1[] does not do justice to the safety profile of edoxaban.
    In the comparison undertaken by Eikelboom et al between the safety profile of warfarin and individual DOACs the 30 mg/day dose of edoxaban was cited as being associated with significantly lower risk of gastrointestinal bleeding than warfarin(Hazard Ratio 0.67; 95% Confidence Interval 0.53-0.83)[2]. This was the dose recommended in patients with body weight 60 kg or less[2].
    In the ELDERCARE-AF randomised clinical care comprising 984 atrial fibrillation patients of mean age 86 a comparison was made between edoxaban 15 mg/day versus placebo. Edoxaban was associated with significantly lower rates of stroke and systemic embolism than placebo, both in frail elderly patients(p=0.02 ) and in non frail elderly(p=0.002), respectively.
    References
    [1]Mitchell A., Watson M., Welsh TJ., McGrogan A
    Safety and effectiveness of anticoagulation therapy in older people with atrial fibrillation d...

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    Conflict of Interest:
    None declared.