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Background <p>Optimal anticoagulation strategies in octogenarians remain controversial owing to age-related risks of thromboembolism and bleeding. This study evaluates real-world outcomes of reduced-dose edoxaban (15–30 mg daily) in very old populations.</p> Methods <p>We conducted a retrospective cohort study of 217 patients (aged ≥ 80 years) receiving edoxaban at Peking University First Hospital (2022–2023). Patients were stratified by dosage (30 mg once daily [QD] [<i>n</i> = 95] versus 15 mg QD [<i>n</i> = 122]). Outcomes included pharmacodynamics (anti-Xa levels), clinical endpoints (bleeding, thrombosis, and mortality), and survival analysis.</p> Results <p>The 15-mg-QD group was older (90.0 versus 85.8 years, <i>P</i> = 0.001) and had reduced activities of daily living (ADL) scores (65.5% versus 82.6, <i>P</i> = 0.003) and reduced estimated glomerular filtration rate (eGFR) (58.6 versus 62.6 mL/min/1.73&#xa0;m<sup>2</sup>, <i>P</i> = 0.005). Anti-Xa peak levels were 0.56 ± 0.25 IU/mL (30 mg) versus 0.35 ± 0.15 IU/mL (15 mg). Over 15.8 ± 9.8 months follow-up, mortality was reduced in the 30-mg group (0.7% versus 3.5%, <i>P</i> = 0.044), with comparable bleeding (3.5% overall) and thrombosis (0.7%) rates.</p> Conclusions <p>Reduced-dose edoxaban demonstrates a favorable safety–efficacy profile in advanced-age patients, necessitating comprehensive bleeding–ischemic risk assessment to optimize individualized anticoagulation regimens.</p>

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Reduced-Dose Edoxaban in Patients Aged ≥ 80 Years: A Single-Center Real-World Analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月13日

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  • Ruiqi Zhang,
  • Jiali Du,
  • Meilin Liu

摘要

Background

Optimal anticoagulation strategies in octogenarians remain controversial owing to age-related risks of thromboembolism and bleeding. This study evaluates real-world outcomes of reduced-dose edoxaban (15–30 mg daily) in very old populations.

Methods

We conducted a retrospective cohort study of 217 patients (aged ≥ 80 years) receiving edoxaban at Peking University First Hospital (2022–2023). Patients were stratified by dosage (30 mg once daily [QD] [n = 95] versus 15 mg QD [n = 122]). Outcomes included pharmacodynamics (anti-Xa levels), clinical endpoints (bleeding, thrombosis, and mortality), and survival analysis.

Results

The 15-mg-QD group was older (90.0 versus 85.8 years, P = 0.001) and had reduced activities of daily living (ADL) scores (65.5% versus 82.6, P = 0.003) and reduced estimated glomerular filtration rate (eGFR) (58.6 versus 62.6 mL/min/1.73 m2, P = 0.005). Anti-Xa peak levels were 0.56 ± 0.25 IU/mL (30 mg) versus 0.35 ± 0.15 IU/mL (15 mg). Over 15.8 ± 9.8 months follow-up, mortality was reduced in the 30-mg group (0.7% versus 3.5%, P = 0.044), with comparable bleeding (3.5% overall) and thrombosis (0.7%) rates.

Conclusions

Reduced-dose edoxaban demonstrates a favorable safety–efficacy profile in advanced-age patients, necessitating comprehensive bleeding–ischemic risk assessment to optimize individualized anticoagulation regimens.