Edoxaban for the Prevention of Stroke in Patients with Atrial Fibrillation

Atrial fibrillation (AF) is a devastating disease in the United States and affects almost 12% of patients who are between the ages of 75 to 84. Having AF almost increases the risk of stroke by 5-fold, and therefore, anticoagulation therapy is essential for the prevention of stroke in patients with AF. Warfarin has been the sole oral anticoagulation available for decades. From 2010 to 2012, 3 additional novel oral anticoagulation (NOAC) came onto the market, which includes dabigatran, rivaroxaban, and apixaban and offered viable alternatives to warfarin for the management of AF. In January 2015, the FDA approved edoxaban, a factor Xa inhibitor, to come onto the market for the prevention of stroke in AF patients. Edoxaban is the third factor Xa inhibitor currently available, in addition to rivaroxaban and apixaban.

 Efficacy of edoxaban for the management of AF was investigated in the ENGAGE-AF TIMI 48 trial. Patients were randomized toreceive warfarin, edoxaban 30 mg, or edoxaban 60 mg daily. Doses of warfarin were adjusted to target international normalized ratio (INR) of 2 to 3.