Apixaban: A novel oral inhibitor of factor Xa

Nutescu, Edith A.

doi:10.2146/ajhp110418

Cited by 31 publications

(23 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6 The cessation of anticoagulation is paramount, and pharmacokinetic data suggest that the elimination half-life in healthy persons is approximately 12 hours. 7 In our patient, acute impairment of renal function during tamponade diminished the drug clearance. Recommendations for decreasing apixaban dosage to 2.5 mg twice daily include 2 of these 3 factors: age, >80 yr; body weight, <60 kg; and creatinine level, >1.5 mg/dL.…”

Section: Discussionmentioning

confidence: 49%

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Lam¹,

Reyes²,

Seger³

2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

We report the case of an 82-year-old A pixaban is a novel oral anticoagulant (NOAC) that is used to prevent stroke in patients who have nonvalvular atrial fibrillation (AF). This drug has predictable therapeutic levels that do not require laboratory monitoring; however, there is no specific antidote to reverse its toxicity.1,2 We present a case of hemorrhagic pericarditis and cardiac tamponade after pacemaker implantation in a patient who was taking apixaban because of AF. Novel therapy and subsequent treatment are discussed. Case ReportAn 82-year-old man with sick sinus syndrome and paroxysmal AF presented at our catheterization laboratory from the clinic, with near-syncope and bradycardia (CHADS 2 score, 2 of 6). On 24-hour Holter monitoring, the predominant result was sinus rhythm. An echocardiogram revealed a normal left ventricular ejection fraction (>0.60), grade II (pseudonormal) diastolic dysfunction, no significant valvular regurgitation, and normal pulmonary artery pressures. A dual-chamber permanent pacemaker was implanted to treat the patient's brady-tachy syndrome and because ventricular pacing revealed pacemaker syndrome (hypotension that results from ventricular pacing due to the absence of the atrial kick that normally increases stroke volume during atrioventricular synchrony). During the procedure, the atrial lead was repositioned. One day postoperatively, the patient was discharged from the hospital after undergoing chest radiography (with normal findings), device interrogation, and incision evaluation. Because of his stroke risk, he was prescribed apixaban (5 mg twice/d) at discharge. He had normal renal function (Table I) and a body weight of 172 lb.During the week after pacemaker implantation, the patient developed fatigue, a low-grade fever (99.2 °F), nausea, moderate pleuritic chest pain, and a productive cough with clear sputum. He was readmitted to the hospital. His blood pressure had decreased from 130/77 mmHg after pacemaker implantation to 100/68 mmHg upon readmission, when he was taking no antihypertensive medications. Physical examination revealed an irregular, tachycardic rhythm (100-130 beats/min), and distended neck veins; auscultation yielded diminished bibasilar breath sounds but no quiet heart sounds. Laboratory data revealed acute kidney injury (Table I) and a substantially elevated erythrocyte sedimentation rate and fibrinogen level. The patient's platelet count and coagulation times were normal; his hemoglobin level had decreased from 15 g/dL after pacemaker implantation to 12 g/dL on readmission. He was taken to the cardiac intensive care unit, where he remained hemodynamically stable.Computed axial tomograms (CT) of the chest (Fig. 1) were not conclusive for right ventricular free-wall perforation, although a moderate-to-large circumferential pericardial effusion of 1.7 cm was detected; its Hounsfield density suggested the presence of Case Reports

show abstract

Section: Discussionmentioning

confidence: 49%

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Lam¹,

Reyes²,

Seger³

2015

Texas Heart Institute Journal

View full text Add to dashboard Cite

show abstract

“…It binds directly to the active site of FXa without requiring AT [31]. Apixaban is rapidly absorbed after oral administration, typically reaching maximal plasma concentration within 1–3.5 h [66,67]. The drug typically reaches steady state within 3 days, and has a half-life of about 12 h [67,68].…”

Section: Apixabanmentioning

confidence: 99%

The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery

Rachidi

Aldin

Greenberg

et al. 2013

Expert Review of Hematology

View full text Add to dashboard Cite

Venous thromboembolism is a common cause of morbidity and mortality among patients undergoing elective orthopedic surgery. Due to the high incidence of venous thromboembolism in this setting, perioperative anticoagulation is the recommended approach for thromboprophylaxis. Low molecular weight heparin (LMWH), fondaparinux and warfarin are the agents commonly used for thromboprophylaxis. The well-recognized limitations of warfarin and the inconvenience and discomfort associated with the subcutaneous administration of low molecular weight heparin and fondaparinux inspired intense investigation to develop novel oral anticoagulants (NOACs) with more predictable pharmacokinetics, fewer drug interactions and no need for regular laboratory monitoring. Three NOACs have been demonstrated to be effective for thromboprophylaxis after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in large randomized controlled trials. Here we review the pharmacology of rivaroxaban, dabigatran, and apixaban, summarize the major clinical trials of these agents in thromboprophylaxis after THA and TKA, and discuss the clinical factors to be considered by providers when selecting a NOAC for their patients.

show abstract

“…Treatment and long-term prevention of venous and arterial thromboembolism is still a therapeutic domain in need for safe, effective, easy-to-use and monitor drugs, as it remains a common cause of mortality and morbidity [1].…”

Section: Introductionmentioning

confidence: 99%

Determination of Apixaban Levels in Human Plasma by a High-Throughput Liquid Chromatographic Tandem Mass Spectrometry Assay / Determinarea rapidă a apixabanului în plasma umană prin cromatografie de lichide de înaltă performanță cuplată cu spectrometrie de masă în tandem

Tilea¹,

Popa²,

Xantus³

et al. 2015

Romanian Review of Laboratory Medicine

View full text Add to dashboard Cite

show abstract

Apixaban: A novel oral inhibitor of factor Xa

Cited by 31 publications

References 82 publications

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

Plasma Exchange for Urgent Apixaban Reversal in a Case of Hemorrhagic Tamponade after Pacemaker Implantation

The use of novel oral anticoagulants for thromboprophylaxis after elective major orthopedic surgery

Determination of Apixaban Levels in Human Plasma by a High-Throughput Liquid Chromatographic Tandem Mass Spectrometry Assay / Determinarea rapidă a apixabanului în plasma umană prin cromatografie de lichide de înaltă performanță cuplată cu spectrometrie de masă în tandem

Contact Info

Product

Resources

About