Apixaban for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism: an evidence-based review

Abstract

Venous thromboembolism (VTE) results in significant morbidity and mortality. The prevention and treatment of VTE is managed with anticoagulant therapy, historically parenteral anticoagulants such as unfractionated heparin, low molecular weight heparin, and fondaparinux, and oral vitamin K antagonists such as warfarin. In the last few years, several target-specific oral anticoagulants have been developed, including the direct thrombin inhibitor dabigatran and anti-Xa inhibitors rivaroxaban, apixaban, and edoxaban. The target-specific oral anticoagulants have proven to be noninferior to vitamin K antagonists and heparins in the prevention and treatment of VTE. This review will focus on the pharmacology, clinical trial data, and laboratory assessment of apixaban. Moreover, perioperative management, use in special populations, and management of bleeding complications in patients taking apixaban for the prevention and treatment of VTE will also be discussed.

Safety and efficacy of apixaban versus warfarin in patients with end‐stage renal disease: Meta‐analysis

“…The study found modest increase in apixaban exposure off hemodialysis and the limited removal of apixaban during hemodialysis in ESRD patients, suggesting the medication can be used without dose modification. FDA, therefore, recommends using the dose of 5 mg twice a day for nonvalvular AF and 2.5 mg twice a day for prevention of thromboembolic recurrence in venous thromboembolism (VTE) . At present, the clinical data are only limited to observational studies included in this analysis.…”

Reduced dose apixaban resolving dual cardiac chamber thrombi in a patient with ischaemic cardiomyopathy in sinus rhythm

“…Apixaban inhibits factor X that is an essential clotting factor in both the intrinsic and extrinsic coagulation pathways. In addition, it inhibits prothrombinase (an enzyme that catalyses conversion of prothrombin to thrombin) and platelet aggregation both of which are essential components in clot development 10. It is also suggested that the decreased thrombin level associated with inhibition of factor X may modify whole blood clot structure to a more penetrable organisation 11.…”

Outcome Analysis of End-to-End and End-to-Side Anastomoses in 131 Patients Undergoing Microsurgical Free Flap Reconstruction of the Lower Extremity

“…11,12 Substitution of heparin is the main therapy in inpatient prophylaxis of thrombosis and new oral anticoagulants need to show efficacy. 13 Nevertheless, thrombotic events are common and major complications in free flap reconstruction of the lower extremity and can lead to flap failure. Fujiki et al observed that venous thromboses are more frequent than arterial thromboses in free flaps to the lower extremities.…”