Incorporating edoxaban into the choice of anticoagulants for atrial fibrillation

Thromb Haemost. 2016 Jan;115(2):257-70. doi: 10.1160/TH15-02-0181. Epub 2015 Oct 15.

Abstract

The non-vitamin K antagonist oral anticoagulants (NOACs) are replacing warfarin for stroke prevention in many patients with nonvalvular atrial fibrillation. Edoxaban, an oral factor Xa inhibitor, is the newest entrant in this class. Results of the Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation (ENGAGE AF) study demonstrate that edoxaban is noninferior to warfarin for prevention of stroke and systemic embolic events, and is associated with significantly less major bleeding, including intracranial bleeding, and reduced cardiovascular mortality. With a net clinical benefit over warfarin, edoxaban is well positioned as a choice among the NOACs, which include dabigatran, rivaroxaban, and apixaban. But how will clinicians choose amongst them? The purpose of this paper is to (a) place the ENGAGE AF trial results into context with results of the studies with the other NOACs, and (b) aid clinicians in selection of the right anticoagulant for the right atrial fibrillation patient.

Keywords: Anticoagulant; atrial fibrillation; edoxaban; non-vitamin K oral anticoagulants.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Oral
  • Aged
  • Anticoagulants / administration & dosage*
  • Anticoagulants / chemistry
  • Atrial Fibrillation / drug therapy*
  • Cardiovascular Diseases / prevention & control
  • Clinical Trials, Phase III as Topic
  • Dabigatran / administration & dosage
  • Embolism / prevention & control
  • Factor Xa Inhibitors / administration & dosage*
  • Factor Xa Inhibitors / chemistry
  • Female
  • Humans
  • Intracranial Hemorrhages / prevention & control
  • Male
  • Pyrazoles / administration & dosage
  • Pyridines / administration & dosage*
  • Pyridines / chemistry
  • Pyridones / administration & dosage
  • Research Design
  • Rivaroxaban / administration & dosage
  • Stroke / physiopathology
  • Stroke / prevention & control
  • Thiazoles / administration & dosage*
  • Thiazoles / chemistry
  • Warfarin / administration & dosage
  • Warfarin / therapeutic use

Substances

  • Anticoagulants
  • Factor Xa Inhibitors
  • Pyrazoles
  • Pyridines
  • Pyridones
  • Thiazoles
  • apixaban
  • Warfarin
  • Rivaroxaban
  • Dabigatran
  • edoxaban