The safety and efficacy of apixaban: where do we stand in 2013?

INTRODUCTION: Traditional oral anticoagulants, such as warfarin, are effective but require frequent laboratory monitoring for dose adjustment and have several known interactions with food and other drugs. Oral direct factor Xa inhibitors are an emerging class of anticoagulants that do not require routine laboratory monitoring. We reviewed the pharmacokinetics and pharmacology as well as the clinical safety and efficacy of apixaban , an oral direct factor Xa inhibitor. AREAS COVERED: Data from Phase II and III clinical trials and secondary analysis involving apixaban were included. Studies using apixaban for stroke prevention in patients with atrial fibrillation, for the prevention and treatment of venous thromboembolism, and for secondary prevention of ischemic events in patients with acute coronary syndromes are discussed. EXPERT OPINION: Apixaban is a safe, effective, and attractive alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. It is also a good option for the prevention of venous thromboembolic events after major orthopedic surgery and for the extended treatment of deep vein thrombosis and pulmonary embolism. Apixaban at a dose of 5 mg twice daily did not have a favorable risk/benefit profile for secondary prevention in high-risk patients with acute coronary syndromes.