Edoxaban (Savaysa®): A Deep Dive

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What is it?

Edoxaban, also known as Savaysa®, is a prescribed medication called an anticoagulant (sometimes called a blood thinner). It’s part of a class of medications called direct oral anticoagulants (DOACs).

Edoxaban is used to treat blood clots—or prevent new ones from forming—in patients with:

“Unlike warfarin, which has been the standard anticoagulant for over half a century, edoxaban is one of the DOACs used to treat patients who either had a clot or are at risk for having a clot,” explained Dr. Christian T. Ruff, an associate physician in the Cardiovascular Division at Brigham and Women’s Hospital in Boston, MA.

How does it work?

Edoxaban prevents clot formation by directly blocking factor Xa in the clotting cascade. “The clotting cascade is how your body forms clots and can be both good and bad. In cases of NVAF or venous thromboembolism (VTE, which includes DVT and PE), we want to limit the body’s ability to form dangerous clots. Edoxaban inhibits a very specific clotting factor (Xa) to help thin the blood,” explains Dr. Ruff.

What are the benefits of taking edoxaban?

  • Edoxaban has similar efficacy and significantly less major bleeding when compared with warfarin or other DOACs.
  • According to 2019 guidelines from the American Society of Clinical Oncology, edoxaban is also one of the recommended DOACs for treating blood clots in patients with cancer (except in cancers of the stomach or small intestine due to an increased bleeding risk). 
  • Edoxaban’s dose is fixed, making it easier to use than warfarin. The recommended oral dose is 60 mg once daily, which can be reduced to 30 mg once daily to prevent bleeding in patients with impaired kidney function or low body weight (<132 lbs).  
  • Edoxaban is a once-daily medication. (Some DOACs need to be taken twice a day.) Patients unable to swallow whole tablets may crush tablets and mix with water.
  • Edoxaban doesn’t require routine blood tests or dietary restrictions. 

What are the risks associated with edoxaban?

Patients on edoxaban must be aware of the increased risk for bleeding. “We know that the only safety risk for edoxaban, which is true for all of the anticoagulants, is that it does increase your risk of bleeding,” explained Dr. Ruff. “But there are no other major side effects of the medication, which has been tested in tens of thousands of patients.”

Dr. Ruff also stressed that serious bleeding is rare. “The risk of serious bleeding with these medications is uncommon – at least 50% less than what we saw with warfarin. We have to remind patients that because these drugs work by preventing clotting, they will increase the risk of nuisance bleeding, such as minor bruising or nosebleeds – but that isn’t a reason to stop taking the medication.”

Safety considerations

If you’re on edoxaban, you can help manage your bleeding risk by: 

  • Taking your medicine as directed. You should never stop your medication or change your dosage without talking to your healthcare provider first. 
  • Telling your healthcare providers about all medicines or supplements that you take—including over-the-counter medications, natural products, and vitamins—to avoid drug interactions. 
  • Avoiding certain anti-infectives (antibiotics and/or antiviral/antifungal medications), other blood thinners (heparin, warfarin), aspirin, ibuprofen, and some seizure medications or certain antidepressants, unless recommended by your healthcare provider.
  • Avoiding contact or high-risk sports. 
    • Activities such as skiing, boxing, or wrestling can pose a bleeding risk for people on blood thinners. Patients should consult with a doctor if they take edoxaban and engage in these activities.
  • Limiting or avoiding alcohol use.
  • Making sure to talk to your healthcare provider before having any type of surgical procedure. 

Pregnancy or breastfeeding considerations

Edoxaban is unsafe to use in pregnancy and is also not recommended for use in patients who are breastfeeding.

For more information about edoxaban, please see our Anticoagulant Comparison Chart!

References

Edoxaban: Drug Information. UpToDate. 2022.

FDA Prescribing Information. 2015.

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