Lixiana (edoxaban) is the fourth Non-vitamin K Oral Anticoagulant (NOAC) in Denmark after Eliques (apixaban), Xarelto (rivaroxaban) and Pradaxa (dabigatran). Lixiana is indicated for the prevention of embolism in patients with nonvalvular atrial fibrillation (NVAF) with one or more risk factors and treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) and prevention of recurrent DVT and PE. For either indication, Lixiana is not inferior to warfarin when it comes to preventing embolism and has a statistically significantly lower occurrence of major bleeding. The lower risk of bleeding is particularly evident in comparisons with patients in warfarin treatment who are not in the therapeutic range in >70 % of the time. There are no available studies directly comparing Lixiana with the other NOACs, and due to variations in the study design, it is difficult to compare the different NOACs.
It is IRF's overall assessment that Lixiana can be used in line with the other NOACs for the prevention of embolism in patients with NVAF or for the treatment of DVT and PE in patients for whom warfarin is contraindicated or where time in the therapeutic range in more than 70 % of the time cannot be achieved with warfarin treatment. The price of Lixiana is currently 4-14% lower than the price of other NOACs.
In patients with NVAF with a renal function in the high end of the normal range (GFR >80-95 mL/min), one of the other NOACs should be preferred over Lixiana as the effect of Lixiana seems to be smaller in this patient group.