The effects of the antiplatelet agents, aspirin and naproxen, on pharmacokinetics and pharmacodynamics of the anticoagulant edoxaban, a direct factor Xa inhibitor

J Cardiovasc Pharmacol. 2013 Aug;62(2):212-21. doi: 10.1097/FJC.0b013e3182970991.

Abstract

Edoxaban is an oral factor Xa (FXa) inhibitor in clinical development for stroke prevention in patients with atrial fibrillation, an elderly population that frequently receives aspirin (ASA) and/or nonsteroidal anti-inflammatory drugs for concurrent illnesses. Three studies were conducted to evaluate the pharmacokinetic and pharmacodynamic interactions of edoxaban 60 mg coadministered with low-dose (100 mg) ASA, high-dose (325 mg) ASA, or naproxen (500 mg) in healthy subjects (n = 126). Template bleeding times (BT) were measured. Mean baseline (predose) BT for the 3 studies ranged from 4.72 to 6.13 minutes. Edoxaban administered alone increased BT by 21%-35% (4 hours post dose) from baseline. Concomitant administration of edoxaban with high-dose ASA, low-dose ASA, or naproxen increased BT approximately 2-fold showing an additive effect greater than either agent administered alone. Edoxaban pharmacokinetics were not affected by concomitant low-dose ASA or naproxen, but high-dose ASA increased systemic exposure of edoxaban by approximately 30%. The effects of edoxaban on prothrombin time, activated partial thromboplastin time, international normalized ratio, anti-FXa, and intrinsic FXa activity were not influenced by administration with ASA or naproxen. Inhibition of platelet aggregation by high-dose ASA, low-dose ASA, or naproxen was not affected by edoxaban. Concomitant administration of edoxaban and ASA or naproxen was well tolerated.

Publication types

  • Clinical Trial
  • Clinical Trial, Phase I
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anti-Inflammatory Agents, Non-Steroidal / administration & dosage
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
  • Anticoagulants / adverse effects
  • Anticoagulants / blood
  • Anticoagulants / pharmacokinetics*
  • Aspirin / administration & dosage
  • Aspirin / adverse effects*
  • Blood Physiological Phenomena / drug effects
  • Cohort Studies
  • Cross-Over Studies
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Interactions
  • Drug Therapy, Combination / adverse effects
  • Factor Xa Inhibitors*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Naproxen / administration & dosage
  • Naproxen / adverse effects*
  • Platelet Aggregation Inhibitors / administration & dosage
  • Platelet Aggregation Inhibitors / adverse effects*
  • Pyridines / adverse effects
  • Pyridines / blood
  • Pyridines / pharmacokinetics*
  • Thiazoles / adverse effects
  • Thiazoles / blood
  • Thiazoles / pharmacokinetics*
  • Young Adult

Substances

  • Anti-Inflammatory Agents, Non-Steroidal
  • Anticoagulants
  • Factor Xa Inhibitors
  • Platelet Aggregation Inhibitors
  • Pyridines
  • Thiazoles
  • Naproxen
  • edoxaban
  • Aspirin