The Direct Oral Anticoagulants Apixaban, Rivaroxaban, and Edoxaban

DeHaas, Keith Alan

doi:10.29074/ascls.30.1.2

Cited by 7 publications

(11 citation statements)

References 9 publications

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“…1 Direct oral anticoagulants (DOACs), apixaban and rivaroxaban, selectively and reversibly inhibit clotting factor Xa (FXa), a major component in the blood coagulation cascade common pathway. 2,3 This mechanism of action decreases active thrombin (factor IIa [FIIa]) generation, resulting in reduced fibrin formation as well as platelet activation. 2,3 Several advantages exist for the use of DOACs over the traditional vitamin K antagonist oral anticoagulant warfarin.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 This mechanism of action decreases active thrombin (factor IIa [FIIa]) generation, resulting in reduced fibrin formation as well as platelet activation. 2,3 Several advantages exist for the use of DOACs over the traditional vitamin K antagonist oral anticoagulant warfarin. This includes minimal monitoring parameters as well as fewer drug-drug and drug-food interactions.…”

Section: Introductionmentioning

confidence: 99%

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Factor VIII Inhibitor Bypassing Activity (FEIBA) Reversal for Apixaban and Rivaroxaban in Patients With Acute Intracranial and Nonintracranial Hemorrhage

et al. 2021

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Background: The clinical use of factor VIII inhibitor bypassing activity (FEIBA) for factor Xa (FXa) inhibitor reversal is derived from small studies with notable variation in patient eligibility for use, dosage regimens, concurrent supportive care, and outcome measures. Consequently, additional effectiveness and safety data are warranted to expand the literature evaluating FEIBA for FXa inhibitor reversal. Objective: This study sought to determine the incidence of observed effective hemostasis within 24 hours of post-FEIBA® administration as well as in-hospital and 30-day post-discharge incidences of thromboembolic event (TEE) and mortality between apixaban and rivaroxaban in the intracranial hemorrhage (ICH) and non-ICH populations. Methods: This case series evaluated patients between January 1, 2014 through July 1, 2019 who received at least one FEIBA® dose for apixaban or rivaroxaban reversal secondary to acute ICH or non-ICH. Patient demographics, FEIBA® dosages, adjunct treatments, effectiveness, and safety outcomes were retrospectively collected from electronic medical record review. Modified hemostasis outcomes, adapted from criteria previously published by Sarode et al., TEE, and mortality between apixaban and rivaroxaban in the ICH and non-ICH populations were evaluated. Results: Among the 104 patients evaluated, 62 received apixaban and 42 rivaroxaban. Thirty apixaban and 25 rivaroxaban users experienced ICH, whereas 32 apixaban and 17 rivaroxaban users experienced non-ICH. Among the combined ICH and non-ICH populations, effective hemostasis occurred in 89%, TEE in 8%, and mortality in 13%. No statistically significant differences were observed within ICH and non-ICH populations receiving apixaban or rivaroxaban regarding effective hemostasis, TEE, or mortality. Conclusion and Relevance: The combined ICH and non-ICH overall rates of effective hemostasis, TEE, and mortality were comparable to preexisting studies of FEIBA for factor Xa inhibitor reversal. The limitations inherent to the study design warrant a randomized controlled trial with an active comparator to confirm these observations.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Factor VIII Inhibitor Bypassing Activity (FEIBA) Reversal for Apixaban and Rivaroxaban in Patients With Acute Intracranial and Nonintracranial Hemorrhage

et al. 2021

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“…Rivaroxaban is a factor Xa inhibitor which directly and reversibly binds to factor Xa and competitively inhibits factor Xa. It is 10,000 fold more selective for factor Xa and it does not require co-factors to exert its anticoagulant effect [20,21]. It is plausible that the enhanced antithrombotic effects of rivaroxaban as opposed to LMWH which acts on factor X indirectly, is associated with a greater perturbation of coagulation and predisposing to more bleeding.…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of enoxaparin versus rivaroxaban in the treatment of cancer associated venous thromboembolism: experience from a tertiary care cancer centre

et al. 2020

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Background: Venous Thromboembolism (VTE) in cancer patients is associated with increased mortality and morbidity. While newer data on use of direct oral anticoagulants (DOACs) in treating cancer associated thrombosis (CAT) is promising; its data is still few and inconsistent across literature. We designed the study to assess if rivaroxaban would be an appealing alternate choice to treat CAT. Methods: We conducted a retrospective study to evaluate the efficacy and safety profile of rivaroxaban versus enoxaparin in cancer patients after developing a symptomatic deep vein thrombosis (DVT) or pulmonary embolism (PE). Baseline patient characteristics and laboratory values were assessed in each arm. Primary efficacy outcome was measured by radiographically confirmed VTE recurrence at different intervals. Primary safety outcome was measured by presence of major and minor bleeding using the ISTH scale. Results: Our study recruited 150 cancer patients with radiologically confirmed DVT and PE; 80 patients were evaluated in enoxaparin arm and 70 patients in rivaroxaban arm. Our results showed that there was no statistically significant difference between the incidence of VTE recurrence at 6 months between the enoxaparin and rivaroxaban arm (10% vs 14.2%, p = 0.42). Historically significant risk factors for VTE in cancer patients such as high platelet count, high leukocyte count, low hemoglobin level, high risk gastrointestinal, genitourinary and lung cancers were not found to be significantly associated with the risk of VTE recurrence. Primary safety outcome analysis also showed no statistically significant difference in major (11.2% vs 11.4%) and minor (15% vs 10%) bleeding between enoxaparin versus rivaroxaban arm respectively (p = 0.65). Conclusion: We conclude that there was no significant difference seen between the efficacy and safety profile of enoxaparin and rivaroxaban in our cancer patient population.

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“…It is 10,000 fold more selective for factor Xa and it does not require cofactors to exert its anticoagulant effect. 21 It is plausible that the enhanced antithrombotic effects of rivaroxaban as opposed to LMWH which acts on factor X indirectly, is associated with a greater perturbation of coagulation and predisposing to more bleeding. We take this as a learning opportunity to consider modifying DOAC doses to best suit your patient's needs depending on their demographic and disease specific details.…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Enoxaparin versus Rivaroxaban in the Treatment of Cancer Associated Venous Thromboembolism: Experience from a Tertiary Care Cancer Centre

Faqah

Sheikh

Bakar

et al. 2020

Preprint

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BACKGROUND VTE in cancer patients is associated with poor prognosis and remains a leading cause of mortality and morbidity. The purpose of this study was to access if rivaroxaban, a oral factor Xa inhibitor would be an appealing alternate choice to treat cVTE compared with LMWH. METHODSWe conducted a retrospective review of comparison between the efficacy and safety profile of enoxaparin versus rivaroxaban in the treatment of venothromboembolism (VTE) in 150 patients with cancer after developing a symptomatic DVT or PE. Baseline patient characteristics and laboratory values were assessed in each arm. Primary efficacy outcome was measured by radiographically confirmed VTE recurrence at different intervals. Primary safety outcome was measured by presence of major and minor bleeding using the ISTH scale. RESULTSOur results showed that there was no statistically significant difference between the incidence of VTE recurrence at 6 months between the Enoxaparin and Rivaroxaban arm (10% vs 14.2%, p=0.42).Historically significant risk factors for VTE in cancer patients such as high platelet count, high leukocyte count, low hemoglobin level, high risk gastrointestinal, genitourinary and lung cancers were not found to be independently significantly associated with the risk of VTE recurrence. Primary safety outcome analysis also showed no statistically significant difference in major (11.2% vs 11.4%) and minor (15% vs 10%) bleeding between enoxaparin versus rivaroxaban arm respectively, (p=0.65). CONCLUSIONWe conclude that there was no significant difference seen between the efficacy and safety profile of enoxaparin and rivaroxaban in our cancer patient population.

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The Direct Oral Anticoagulants Apixaban, Rivaroxaban, and Edoxaban

Cited by 7 publications

References 9 publications

Factor VIII Inhibitor Bypassing Activity (FEIBA) Reversal for Apixaban and Rivaroxaban in Patients With Acute Intracranial and Nonintracranial Hemorrhage

Factor VIII Inhibitor Bypassing Activity (FEIBA) Reversal for Apixaban and Rivaroxaban in Patients With Acute Intracranial and Nonintracranial Hemorrhage

Comparative analysis of enoxaparin versus rivaroxaban in the treatment of cancer associated venous thromboembolism: experience from a tertiary care cancer centre

Comparative Analysis of Enoxaparin versus Rivaroxaban in the Treatment of Cancer Associated Venous Thromboembolism: Experience from a Tertiary Care Cancer Centre

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