Introduction
Direct oral anticoagulants (DOACs) are widely used for treatment and
prophylaxis of atrial fibrillation (AF), ischemic stroke, deep vein
thrombosis (DVT), and pulmonary embolism (PE). The recent 2019
AHA/ACC/HRS Focused Update of the 2014 guidelines for management of
patients with AF states that DOACs are recommended over warfarin in
eligible patients [1]. Although warfarin has been the most widely
used oral anticoagulant, due to its shortcomings including a narrow
therapeutic range and wide inter-and intra-individual variability
[2], DOACs are currently preferred in many clinical settings [3,
4].
Among DOACs, edoxaban is the most recently introduced drug [5] and
has mainly been used as an alternative to other DOACs. However, after
many studies showed that both high-dose and low-dose edoxaban were not
inferior to warfarin for stroke prevention and associated with a
significantly lower incidence of bleeding complications [6-9],
edoxaban became a representative DOAC [1]. Hence, edoxaban is likely
to be prescribed more widely in the future, depending on the clinical
setting or patient profile.
Bleeding complication is one of the major concerns during edoxaban usage
[10]. The generally recommended dose of edoxaban for treatment of
DVT/PE and AF is 60 mg once daily. In order to reduce the incidence of
bleeding complications, patients with creatinine clearance (CrCl) 15 to
50 mL/min, weights of less than or equal to 60 kg, or who are taking
certain concomitant P-glycoprotein (P-gp) inhibitors are recommended to
take 30 mg once daily for treatment of DVT and PE instead [5].
However, Asian patients are known to be more prone to bleeding
complications than patients of other ethnicities [11], opening
possibilities of other risk factors that should be given special
consideration for dosage adjustment in this specific ethnic group. In
this context, this study aimed to provide evidence of the association
between risk factors and bleeding complications in Asian patients with
an appropriate edoxaban dosage regimen.