Edoxaban effects on bleeding following punch biopsy and reversal by a 4-factor prothrombin complex concentrate.

Edoxaban is a non-vitamin K oral anticoagulant (NOAC) that directly inhibits factor Xa. The efficacy and safety of this agent have been demonstrated in the prevention of stroke in patients with atrial fibrillation and in the treatment of venous thromboembolism. As for the other NOACs, no specific antidote is available to antagonise the anticoagulation effect obtained with edoxaban in case of bleeding or emergency intervention.

In this study, Zahir et al. investigated the effect of 3 different doses (10, 25, 50 UI/kg) of a 4-factor prothrombin complex concentrate (PCC) on bleeding (bleeding duration/volume after punch biopsy) and coagulation assays (endogenous thrombin potential) in healthy subjects after administration of 60 mg edoxaban.

The authors observed that intravenous administration of 4-factor PCC was associated with a dose-dependent reduction of bleeding duration and an increase in endogenous thrombin potential. Although a partial reversal was observed with 25 UI/kg 4-factor PCC, a dose of 50 UI/kg was required to completely reverse the effect of edoxaban.

The results of this interesting study suggest that 50 UI/kg PCC could be safely used to reverse the effect of edoxaban in bleeding patients and/or patients requiring emergency procedures. Further studies are needed to assess the efficacy and safety of this therapeutic approach in different clinical scenarios.

– David Faraoni

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