Apixaban vs Edoxaban for DVT Treatment

Primary Guideline Recommendations

The American College of Chest Physicians (CHEST) provides strong recommendations for both apixaban and edoxaban over vitamin K antagonists for DVT treatment, with moderate-certainty evidence supporting their equivalent efficacy and safety profiles 1, 2
The CHEST guidelines recommend apixaban, dabigatran, edoxaban, or rivaroxaban over VKA as treatment phase (first 3 mo) anticoagulant therapy for patients with acute VTE (DVT of the leg or PE) 1, 2

The American College of Chest Physicians (CHEST) notes that apixaban does not require initial parenteral anticoagulation, while edoxaban requires 5-10 days of heparin before initiation 1, 2
Apixaban has approximately 27% renal elimination, making it safer in moderate renal impairment 3, 4
Edoxaban requires 5-10 days of initial heparin therapy before starting edoxaban, and has a dosing regimen of 60 mg once daily (or 30 mg if CrCl 30-50 mL/min or body weight <60 kg) 4, 5

The Hokusai-VTE trial (n=8,240) found that edoxaban had a recurrent VTE risk ratio of 0.83 (95% CI 0.57-1.21) and a major bleeding risk ratio of 0.85 (95% CI 0.6-1.21) compared to warfarin 4, 5
The trial also found that edoxaban had an all-cause mortality risk ratio of 1.05 (95% CI 0.82-1.33) compared to warfarin, which was not significantly different 4, 5

The American College of Chest Physicians (CHEST) provides a strong recommendation for oral Xa inhibitors (including both apixaban and edoxaban) over LMWH for cancer-associated thrombosis, but notes that apixaban may be preferred in patients with luminal GI malignancies due to lower GI bleeding risk compared to edoxaban 2
For patients with severe renal impairment (CrCl <15 mL/min), apixaban should be avoided and edoxaban is also contraindicated 3
For patients with moderate renal impairment (CrCl 30-50 mL/min), both agents can be used with dose adjustments, and edoxaban has specific dosing guidance 3, 4

The American College of Chest Physicians (CHEST) recommends a minimum 3-month treatment phase with both apixaban and edoxaban 1, 2, 6
Extended therapy decisions should be based on provocation status and bleeding risk, not on choice between these two agents 1, 2