The Edoxaban saga

[wilsond]

sciencedirect.com/science/a....

Interesting article here

[BobD Volunteer]

Dated November 2015 so just as edoxaban was coming out. Apixaban is still judged best by my EP.

[jeanjeannie50 in reply to BobD]

My very experienced AF nurse said she thought she'd never believe anything could be as reliable as Warfarin, but she's now added Apixaban as is very impressed with that drug.

[BobD Volunteer in reply to jeanjeannie50]

Indeed Jean. JC asked my last year for the first time if I wanted to change but having just managed to get my own Coaguckek I declined. Maybe in 2 years when I hit 80.

[talipia in reply to jeanjeannie50]

How does Aspirin75mg compare with these more esoteric pharmaceuticals?

[wilsond in reply to talipia]

Aspirin cannot be compared to either as it works on the platelets in the blood,a true ' blood thinner'

The other drugs work on the clotting process to slow it down.

In UK and Europe ,aspirin is not prescribed for AF patients as a guard against stroke.

[frazeej in reply to wilsond]

Similar in the U.S.; DOAC for Afib, not aspirin.

[wilsond in reply to BobD]

Yes and mine too Jean x

[OldJane]

not sure using a 2015 article would be a “gotcha” to a cash strapped service. But I don’t want to change from Apixaban so hope not to have the argument.

[Ppiman]

Studies like that have me in awe of the kind of brains some medical scientists must have!

I'm glad I switched to apixaban, but I have read that edoxaban is considered comparable.

Steve

[wilsond in reply to Ppiman]

Yes agree! Different breed! found it interesting

[ozziebob]

But please don't forget this research done in Germany that shows Edoxaban in a much better light ...

pubmed.ncbi.nlm.nih.gov/347...

I know my supposed "informed choice" stands on shifting sands. It was ever thus.

[Dippy22]

I’m on Edoxaban and what I find a tad concerning is there isn’t an antidote. 😟

[ozziebob in reply to Dippy22]

Yes, I understand your concerns. This concern was highlighted recently by a.n. other and I will rePost my reply from that Post in the hope it might be true (perhaps others can contribute if this information is unintentionally misleading or out of date) ...

"I found this in a European Medicines Agency article on Edoxaban ...

"For life-threatening bleeding that cannot be controlled with the measures such as transfusion or haemostasis, the administration of a 4-factor prothrombin complex concentrate (PCC) at 50 IU/kg has been shown to reverse the effects of edoxaban 30 minutes after completing the infusion." "

[Dippy22 in reply to ozziebob]

Sadly the manufacturers of Edoxaban haven’t updated the packaging with that info.

Well this is Wikipedia;

Edoxaban overdose can cause serious bleeding.[2]No approved antidotes for edoxaban overdose exist as of April 2021.[2] Hemodialysis does not significantly contribute to edoxaban clearance.[1][11]Andexanet alfa has been studied as an antidote for edoxaban overdose, but has only been approved for reversing rivaroxaban and apixaban effects by the FDA and the EMA as of 2019.[12][13]

Bucks Formulary NHS;

There is currently no licensed antidote for the reversal of anticoagulant effect of edoxaban(although products are available to help counteract the anticoagulant effect, such as tranexamic acid and prothrombin complex concentrate).

PubMed;

.There are two specific reversal agents (antidotes) approved for reversal of a DOAC: idarucizumab is approved for reversal of the direct thrombin inhibitor dabigatran, and andexanet alfa is approved for reversal of the direct FXa inhibitors apixaban and rivaroxaban (table 2).18,19 There are currently no approved reversal agents for the other direct FXa inhibitors; edoxaban and betrixaban. LMWH can be reversed by protamine, which is a highly cationic peptide that binds unfractionated heparin completely or LMWH partially, to form a stable inactive salt pair that has no anticoagulant activity.

Seems the jury is out on this one Bob. To be honest I’m surprised they’re rolling it out quite so enthusiastically. Maybe this is why it’s “cheaper”. 😟

[MarkS]

I'm not sure this study is worth the paper it's written on. Two of the researchers worked for Bristol-Myers Squibb and Pfizer, who jointly developed apixaban, and no one from Daichi Sankyo, the manufacturer of Edoxaban. So it was always going to produce a result favourable to apixaban. Things have moved on and edoxaban seems just as effective.

[CDreamer]

Very interesting and thanks for posting. And that was on 2012 pricing so before generic Apixaban.