Introduction: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. Prior to this decade, treatment options

 

Abstract

Introduction: Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide. Prior to this decade, treatment options were limited to warfarin or parenteral agents. The emergence of the direct oral anticoagulants (DOACs) offers patients a more convenient and accessible alternative. Apixaban (Eliquis®) is an oral, direct factor Xa inhibitor that is approved for the acute treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as for the reduction in the risk of recurrent DVT and PE following initial therapy. Like other DOACs, apixaban has predictable pharmacological properties including fixed dosing, few drug interactions and no requirement for routine anticoagulation monitoring.Areas Covered: This article reviews results from preclinical and healthy volunteer studies that illustrate the noteworthy properties of apixaban such as a proportional dose-response relationship, low daily fluctuation in plasma concentrations, and safety over a 10-fold dosing range. Additionally, the large phase III trials evaluating the safety and efficacy of apixaban compared to low molecular weight heparin (LMWH) overlapped with and followed by vitamin K antagonist (VKA) warfarin for the treatment and secondary prevention of VTE will be discussed. The key studies that have led to apixaban's current licensing and use will be highlighted including the trials in the acute treatment of VTE where apixaban demonstrated noninferior efficacy and a reduced risk of bleeding in comparison to VKA, and in extended prophylaxis trials where apixaban reduced the risk of VTE/VTE-related deaths, with no increased risk of relevant bleedings in comparison to placebo. This review also will provide an overview of special populations where future areas of research is needed.Expert Commentary: Apixaban offers several advantages over historical therapy for the treatment and secondary prevention of VTE and is currently considered and widely used in many countries, along with other DOACs, as first line therapy for this indication. Importantly, there are many populations in which the use of apixaban has not been extensively studied. Large clinical trials had a low representation of patients > 75 years old, with cancer, low or high body weight, or poor renal function. Likewise, there is a dearth of data on pediatric patients and patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia. Additional comparator studies on anticoagulation reversal involving andexanet alfa are also necessary to further assess its ability to sustain hemostasis and its potential for prothrombotic risk.

PMID: 31958251 [PubMed - as supplied by publisher]

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//www.ncbi.nlm.nih.gov/corehtml/query/egifs/https:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif Related Articles

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