Apixaban

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Contents

Introduction

An oral, specific factor Xa inhibitor. Evidence exists for the indications of thromboprophylaxis[1], in prevention of thromboembolic stroke in atrial fibrillation[2] and in treatment of VTE. It is unclear as of 2011 if the drug may be associated with a higher death rate than standard thromboprophylaxis due to non VTE/bleeding issues but it is notably superior to both aspirin [2] and warfarin[3] in atrial fibrillation. It appears unlikely to be useful combined with aspirin in acute coronary syndrome[4]. Extended thromboprophylaxis in medical patients for 30 days with apixaban was not superior to a shorter course of up to 14 days with enoxaparin[5]. However all cause mortality was reduced in younger patients with VTE if it was given at doses of 2.5mg bd or 5mg bd for a year following an initial 6 months treatment with full anticoagulation for the VTE event .

Clinical Use

Indications

  • Prevention of venous thromboembolic events (VTE) in adult patients who have undergone elective hip or knee replacement surgery
  • Prevention of stroke in non valvular atrial fibrillation
  • Treatment and prevention of recurrent VTE

Administration

Oral

  • Thromboprophylaxis 2.5 mg bd.
  • In atrial fibrillation to prevent stroke 2.5 to 5 mg twice a day

Clinical Issues

Contra-indications

As of 2015 these are still evolving so prescribers should see the latest medicines regulation advice for your jurisdiction.

Cautions and Interactions

Side effects

  • Bleeding

Special advice

Appears to be better tolerated than aspirin.

Pharmacology

References

  1. Ufer M. Comparative efficacy and safety of the novel oral anticoagulants dabigatran, rivaroxaban and apixaban in preclinical and clinical development. Thrombosis and haemostasis. 2010 Mar 1; 103(3):572-85.(Link to article – subscription may be required.)
  2. a b Apixaban in Patients with Atrial Fibrillation Connolly SJ, Eikelboom J, Joyner C et al NEJM 10.1056/NEJMoa1007432 Accessed 10 February 2011
  3. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, Al-Khalidi HR, Ansell J, Atar D, Avezum A, Bahit MC, Diaz R, Easton JD, Ezekowitz JA, Flaker G, Garcia D, Geraldes M, Gersh BJ, Golitsyn S, Goto S, Hermosillo AG, Hohnloser SH, Horowitz J, Mohan P, Jansky P, Lewis BS, Lopez-Sendon JL, Pais P, Parkhomenko A, Verheugt FW, Zhu J, Wallentin L. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine. 2011 Sep 15; 365(11):981-92.(Link to article – subscription may be required.)
  4. Alexander JH, Lopes RD, James S, Kilaru R, He Y, Mohan P, Bhatt DL, Goodman S, Verheugt FW, Flather M, Huber K, Liaw D, Husted SE, Lopez-Sendon J, De Caterina R, Jansky P, Darius H, Vinereanu D, Cornel JH, Cools F, Atar D, Leiva-Pons JL, Keltai M, Ogawa H, Pais P, Parkhomenko A, Ruzyllo W, Diaz R, White H, Ruda M, Geraldes M, Lawrence J, Harrington RA, Wallentin L. Apixaban with antiplatelet therapy after acute coronary syndrome. The New England journal of medicine. 2011 Aug 25; 365(8):699-708.(Link to article – subscription may be required.)
  5. Goldhaber SZ, Leizorovicz A, Kakkar AK, Haas SK, Merli G, Knabb RM, Weitz JI. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients. The New England journal of medicine. 2011 Dec 8; 365(23):2167-77.(Link to article – subscription may be required.)