The new oral anticoagulants for VTE – Comparison (Advantages, Disadvantages)
Dabiagatran
(Pradaxa)
Rivaroxaban
(Xarelto)
Apixaban
(Eliquis)
Edoxaban
(Savaysa)
no
yes
yes
no
twice daily
once daily
twice daily
once daily
Renal clearance
80 %
33 %
25 %
35 %
Efficacy compared to warfarin
(recurrent VTE)
Safety compared to warfarin
in respect to relevant bleeding
Reversal agent / antidote
available for major bleeding 4
FDA approved for VTE
treatment
same
same
same
same
same
same/better1
better 2
better 3
none
none
none
none
yes
yes
yes
yes
Started immediately upon
diagnosis of VTE
Dosing
“Major bleeding” same as with warfarin in DVT trial, but less in PE trial
Less “major bleeding” with apixaban
3 Less “clinically relevant bleeding” with edoxaban, same “major bleeding”
4 reversal agents are in early clinical development for all 4 anticoagulants
1
2
References
1. HOKUSAI-Investigators. Edoxaban versus warfarin for the treatment of
symptomatic venous thromboembolism. N Engl J Med 2013;Sept 1.
2. Agnelli G et al. Oral Apixaban for the Treatment of Acute Venous
Thromboembolism. N Engl J Med, 369:799-808.
3. The Einstein Investigators: Oral Rivaroxaban for symptomatic venous
thromboembolism. New Engl J Med 2010;363:2499-510.
4. The Einstein Investigators: Oral Rivaroxaban for the treatment of
symptomatic pulmonary embolism. New Engl J Med 2012;366:1287-97.
5. Schulman s et al. Dabigatran versus warfarin in the treatment of acute
venous thromboembolism. N Engl J Med. 2009 Dec 10;361(24):2342-52.