Current clinical use of edoxaban 15 mg in hospitalized patients with heart failure: analysis from the JROAD-DPC database
Y Fujimoto, K Kanaoka, Y MatsueAbstract
Background
Heart failure (HF) is a complex systemic syndrome frequently accompanied by multiple comorbidities, including atrial fibrillation, coronary artery disease, and frailty. Given this high burden of multimorbidity, patients with HF often require anticoagulation therapy, while bleeding risk is pronounced especially in older and frail individuals. In Japan, edoxaban 15 mg has recently emerged as a reimbursed dose of a direct oral anticoagulant (DOAC). However, there is little contemporary evidence describing the characteristics, temporal trends, and in-hospital outcomes associated with edoxaban 15 mg compared with other DOAC regimens in hospitalized patients with HF.
Purpose
To characterize hospitalized patients with HF who receive edoxaban 15 mg and compare their in-hospital outcomes with those receiving other DOAC doses using a nationwide database.
Methods
We performed a retrospective analysis of DOAC use in patients hospitalized for acute heart failure (AHF) using a nationwide database covering 2020 to 2024. A total of 131,498 patients who received a DOAC within two days of admission (median age 84 [77–89] years; 48% women) were included.
Results
Edoxaban 15 mg was prescribed in 15,646 patients, and its prescription proportion among all DOACs increased from 3.2% in 2020 to 20.4% in 2024. Compared with patients receiving other DOACs, those prescribed edoxaban 15 mg were older, more often women, had lower body mass index, required higher levels of nursing care, and had a more frequent history of anemia. After 1:1 propensity score matching, 12,082 pairs were generated with all standardized mean differences <0.01. In-hospital outcomes including all-cause death (9.6% vs. 9.7%), transfusion of ≥4 units (1.1% vs. 1.3%), and stroke (0.7% vs. 0.8%) were comparable between groups. Exploratory subgroup analyses suggested that edoxaban 15 mg use might be associated with lower mortality in patients receiving antiplatelet therapy (P for interaction = 0.017) and in those with a higher frailty index (P for interaction = 0.054).
Conclusions
Among hospitalized patients with AHF, the proportion of edoxaban 15 mg prescriptions has markedly increased over recent years. After propensity score matching, in-hospital outcomes were comparable between patients receiving edoxaban 15 mg and those receiving other DOAC doses.