Betrixaban in the Prevention of Venous Thromboembolism in Medically Ill Patients

Despite significant advances in strategies and compliance with venous thromboembolism (VTE) prophylaxis, hospital-acquired VTE remains a leading cause of preventable deaths in acute medically ill patients. A majority of venous thromboembolic events occur posthospital discharge when risk factors persist and pharmacoprophylactic regimens have been completed. Until recently, there has been an unmet need for safe and effective extended-duration VTE prevention. Three major trials evaluated this concept, but excess bleeding outweighed the benefit of reduced thromboembolic events. Betrixaban is an oral direct factor Xa inhibitor recently approved for extended-duration VTE prophylaxis in acute medically ill patients at risk for thromboembolism based on results from the Phase III APEX study. This article reviews the pharmacology and supporting data for betrixaban.