Korean Circ J.
2025 Mar;55(3):215-227. 10.4070/kcj.2024.0222.
Increasing Very Low-Dose Edoxaban Prescription: Effectiveness and Safety Data of Korean AF Patients
- Choi J
1 - Yang SY2
- Lee SR1,3
- Cho MS2
- Lee KY1
- Ahn HJ1
- Kwon S4
- Cha MJ2
- Kim J2
- Nam GB2
- Choi KJ2
- Choi EK1,3
- Oh S1,3
- Lip GYH3,5,6
- Affiliations
-
- 1Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
- 2Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- 4Division of Cardiology, Department of Internal Medicine, Seoul Boramae Medical Center, Seoul, Korea
- 5Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Chest & Heart Hospital, Liverpool, United Kingdom
- 6Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- KMID: 2565813
- DOI: http://doi.org/10.4070/kcj.2024.0222
Abstract
- Background and Objectives
Evidence remains limited on the real-world prescription of very low-dose oral anticoagulation among frail patients with atrial fibrillation (AF). We described the practice patterns, effectiveness, and safety of very low-dose edoxaban (15 mg once daily).
Methods
Patients with AF prescribed edoxaban 15 mg once daily in 2 tertiary hospitals between 2016 and September 2022 were included. Baseline clinical characteristics and clinical outcomes of interest were thromboembolic and bleeding events.
Results
A total of 674 patients were included (mean age 78.3±9.1, 49.7% aged ≥80 years, 49.3% women, median follow-up 1.0±1.2 years). Mean CHA 2 DS 2 -VASc score was 3.9±1.6, and the modified HAS-BLED score was 2.0±1.1. Between 2016 and 2022, the number of very lowdose edoxaban prescriptions increased. The main reasons for the prescription of very lowdose were low body weight (55.5% below 60 kg), anaemia (62.8%), chronic kidney disease (40.2%), active cancer (15.3%), concomitant anti-platelet use (26.7%), and prior major bleeding (19.7%). During a median follow-up duration of 8 (interquartile range 3–16) months, overall thromboembolic and bleeding events occurred in 16 (2.3%) and 88 (13.1%) patients, respectively. Compared to the expected event rates on the established risk scoring systems, patients receiving very low-dose edoxaban demonstrated a 61% reduction in ischemic stroke, a 68% reduction of ischemic stroke/transient ischemic attack/systemic embolism, whereas a 49% increase in major bleeding.
Conclusions
The prescription of very low-dose edoxaban was increased over time, attributable to various clinical factors. The use of very low-dose edoxaban reduced the expected risk of thromboembolic events.
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