NHS Greater Glasgow & Clyde Area Drug and Therapeutics Committee
Greater Glasgow and Clyde Medicines
Medicines Update

Edoxaban is the DOAC of choice in non-valvular atrial fibrillation

The following is a joint quote from David Murdoch, Chair of the Heart MCN and Christine McAlpine, Chair of the Stroke MCN in NHSGGC.

 “The Heart MCN supported by the Stroke MCN have updated the atrial fibrillation (AF) guidance to include edoxaban as the direct oral anticoagulant (DOAC) of choice in the management of patients with AF who do not have a metallic prosthetic valve or mitral stenosis. This decision is based on clinical evidence (including a review carried out by Heath Improvement Scotland) suggesting only marginal differences in clinical efficacy between the different DOACs but significant differences in cost. The new guidance is applicable in both secondary and primary care settings and the formulary status of edoxaban has been changed to reflect the change in the guideline.  Edoxaban should now be considered first line for all new initiations for AF.  A switch programme to manage existing patients on other DOACs for AF will be managed in primary care.”

Important prescribing note (refer to edoxaban SPC for full prescribing advice):

  • The recommended dose of edoxaban for the prevention of stroke and systemic embolism in adult patients with non-valvular AF is 60 mg once daily
  • The dose of edoxaban should be reduced to 30 mg once daily in patients with one or more of the following clinical factors:
    • Moderate or severe renal impairment (CrCL 15 - 50 mL/min).
      To calculate CrCL, use the electronic calculator within the GGC Medicines App or on StaffNet here)
    • Low body weight ≤ 60 kg
    • Concomitant use of the following P-glycoprotein (P-gp) inhibitors: ciclosporin, dronedarone, erythromycin, or ketoconazole.

Further information on DOACs can be found in the DOAC FAQ which has been updated to reflect edoxaban as DOAC of choice for AF.

Published 03/05/18

Post publication update:

A DOAC patient information booklet and alert card is now available. Click here for further information.