Efficacy and safety of edoxaban in patients with cardioembolic stroke

Ischemic strokes due to cardiogenic embolism are associated with an increased risk of death or permanent disability, which emphasizes the importance of their prevention. Edoxaban is a Xa inhibitor that is widely used globally as a new oral anticoagulant to prevent thromboembolic complications in patients with atrial fibrillation and an increased risk of stroke. The purpose of this review is to summarize data on the efficacy and safety of edoxaban in the secondary stroke prevention. The literature review was conducted using PubMed and Medscape databases to search for publications on clinical trials and clinical guidelines on oral anticoagulant treatment for stroke prevention. The results of clinical trials show that in patients with atrial fibrillation, edoxaban is non-inferior to warfarin in efficacy for primary and secondary stroke prevention, but compared to warfarin, edoxaban treatment is much safer (significantly reduces the risk of serious bleedings, including intracranial ones). The safety profile of edoxaban makes it one of the best drugs for the treatment of elderly patients and those with chronic kidney disease. In general, the results of recent clinical trials indicate that in cardioembolic stroke due to atrial fibrillation, the early initiation of treatment with direct oral anticoagulants is safe and reduces the risk of recurrent embolic events. Timely determination of the etiological subtype of ischemic stroke, in particular the detection of paroxysmal atrial fibrillation, and consideration of individual patient characteristics are the key to an optimal secondary prevention strategy that minimizes the risk of recurrent brain damage and improves the quality of life after stroke.