Apixaban for the prevention of stroke in atrial fibrillation

Littrell, Rachel; Flaker, Greg

doi:10.1586/erc.11.187

Cited by 2 publications

(6 citation statements)

References 26 publications

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“…Apixaban is superior to warfarin for prevention of stroke in AF. [48] It has been studied extensively in the AVERROES and ARISTOTLE trials. In AVERROES as compared with aspirin it has been shown to reduce the incidence of VTE.…”

Section: Factor Iia Inhibitorsmentioning

confidence: 99%

New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly

2013

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With the adoption of dabigatran, rivaroxaban, and apixaban into clinical practice, a new era has arrived in the practice of oral anticoagulants. Venous thromboembolism (VTE) has traditionally been underdiagnosed and under treated in Asia. With increasing longevity, the diagnosis and the need for management of atrial fibrillation (AF) and VTE is likely to increase significantly. The new orally active anticoagulants (NOACs) have reasonably filled the lacunae that clinicians traditionally faced when treating patients with vitamin K antagonist (VKA). Unlike VKA, NOACs do not need frequent monitoring. Therefore, more patients are likely to get therapeutic effects of anticoagulation and thus reduce morbidity and mortality associated with VTE and AF. However, the clinicians need to be circumspect and exercise caution in use of these medications. In particular (in geriatric population), the clinicians should look out for drug-drug interactions and underlying renal insufficiency. This would ensure therapeutic efficacy and minimize bleeding complications. Here, it is important to note that the antidote for NOACs is not available and is a major concern if emergency surgical procedure is required in their presence.

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Section: Factor Iia Inhibitorsmentioning

confidence: 99%

New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly

2013

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“…The selection of an anticoagulant should be made based on the absolute risk of bleeding, and the relative risk and benefit for a given patient (Littrell & Flaker, 2012) …”

Section: Clinical Judgment and Pharmacotherapymentioning

confidence: 99%

“…Xa, with a half-life around 12 hours, >50% bioavailability and plasma levels are achieved in 3 hours (Littrell & Flaker, 2012;Lopes et al, 2010). It also inhibits clot bound factor Xa in vitro (Jiang, cited in Nutescu, 2012).…”

Section: Pharmacology Apixaban Is An Orally Active Selective Inhibitmentioning

confidence: 99%

“…It also inhibits clot bound factor Xa in vitro (Jiang, cited in Nutescu, 2012). Interestingly, it has a 3.5-fold less peak-to-through fluctuation than rivaroxaban, which could theoretically improve its benefit-risk profile (Littrell &Flaker, 2012). Similarly to rivaroxaban, there is no need for regular monitoring and dose titration.…”

Section: Pharmacology Apixaban Is An Orally Active Selective Inhibitmentioning

confidence: 99%

“…Different than dabigatran and rivaroxaban, apixaban has a predominantly non-renal (75 %) clearance and is metabolized primarily by the liver via the CYP3A4 and other mechanisms (Littrell & Flaker, 2012), which are attractive properties for the management of patients with kidney impairment. Following, the two RCTs available for apixaban will be discussed.…”

Section: Pharmacology Apixaban Is An Orally Active Selective Inhibitmentioning

confidence: 99%

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Oral anticoagulants and clinical decision making for stroke prevention in non-valvular atrial fibrillation for nurse practitioners

Queiroz¹

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This literature review explored the question of which oral anticoagulant offers the best efficacy and safety for stroke prevention in non-valvular atrial fibrillation and how the nurse practitioner should select appropriate anticoagulation for these patients. The findings of this review demonstrate that warfarin remains a safe, effective and affordable therapy.Dabigatran, rivaroxaban and apixaban, offer an alternative for those patients that cannot tolerate warfarin, or who will benefit from their unique features, but further research is needed to address their limitations. The most appropriate therapy will depend on the individual context of each patient, and the nurse practitioner should assess all variables and discuss them with the patient before making a decision. Further research and surveillance are necessary to understand the role , use , side effects and impact of new oral anticoagulation in practice. This review offers recommendations that the nurse practitioner can apply to deliver care tailored to each patient. Abstract Table of Contents

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Apixaban for the prevention of stroke in atrial fibrillation

Cited by 2 publications

References 26 publications

New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly

New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly

Oral anticoagulants and clinical decision making for stroke prevention in non-valvular atrial fibrillation for nurse practitioners

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