Use of Clinical Factors Alone in Tailoring Edoxaban Dose in Atrial Fibrillation

Edoxaban is a new target-specific oral anticoagulant that directly inhibits factor Xa (FXa). In a recent trial, edoxaban was shown to be noninferior to warfarin in preventing thromboembolic events and less likely to result in major bleeding or cardiovascular mortality in patients with atrial fibrillation. Now, in an industry-funded study, investigators analyzed whether edoxaban dose reductions made based on patient clinical characteristics resulted in reduced efficacy or safety in comparison with warfarin.

Of the 21,105 patients randomly assigned to receive warfarin (dose-adjusted international normalized ratio, 2–3), higher-dose edoxaban (60 mg once daily), or lower-dose edoxaban (30 mg once daily), edoxaban doses were halved (i.e., to 30 m…