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From The Medical Letter on Drugs and Therapeutics
July 7, 2015

Edoxaban (Savaysa)—The Fourth New Oral Anticoagulant

JAMA. 2015;314(1):76-77. doi:10.1001/jama.2015.7098

The FDA has approved edoxaban (Savaysa – Daiichi Sankyo), a once-daily, oral, direct factor Xa inhibitor, for treatment of venous thromoboembolism (VTE) and for prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (Table 1). It is the fourth new oral anticoagulant to be approved for VTE and nonvalvular atrial fibrillation.

Acute VTE (deep vein thrombosis or pulmonary embolism) is usually treated initially with a parenteral anticoagulant such as unfractionated heparin, low molecular weight heparin (LMWH), or fondaparinux (Arixtra, and generics). Warfarin (Coumadin, and others) is started on the same day as parenteral therapy and titrated to an INR of 2-3. After ≥5 days, the parenteral anticoagulant is stopped and warfarin is continued as monotherapy. The new oral anticoagulants dabigatran etexilate (Pradaxa), rivaroxaban (Xarelto), and apixaban (Eliquis) all appear to be effective and safe alternatives to warfarin for treatment of acute VTE, but data in elderly patients and those with significant comorbidities are limited. Treatment of acute VTE usually continues for at least 3 months.1,2

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