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Apixaban: A Review in Venous Thromboembolism

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Abstract

Apixaban (Eliquis®) is an oral, direct factor Xa inhibitor that is available for use in the treatment and secondary prevention of venous thromboembolism (VTE). Like other direct oral anticoagulants (DOACs), apixaban has generally predictable pharmacological properties and does not require routine anticoagulation monitoring. In large phase III trials, oral apixaban was noninferior to subcutaneous enoxaparin sodium overlapped with and followed by oral warfarin (enoxaparin/warfarin) in the treatment of adults with acute VTE over 6 months with regard to the incidence of recurrent VTE or VTE-related death (AMPLIFY), and was significantly more effective than placebo in the prevention of recurrent VTE or all-cause mortality over 12 months in patients who had completed 6–12 months’ anticoagulation treatment for VTE (AMPLIFY-EXT). Apixaban was generally well tolerated in these trials; the risks of major bleeding and the composite endpoint of major or clinically relevant nonmajor (CRNM) bleeding with apixaban were significantly lower than enoxaparin/warfarin in AMPLIFY and not significantly different from that of placebo in AMPLIFY-EXT. Similarly, in Japanese adults with acute VTE (AMPLIFY-J), apixaban was associated with a significantly lower risk of major or CRNM bleeding than unfractionated heparin plus warfarin, and no cases of recurrent VTE or VTE-related death over 24 weeks. Thus, apixaban is useful therapeutic alternative for the management of adults with VTE.

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Acknowledgments

During the peer review process, the manufacturer of apixaban was also offered an opportunity to review this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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  1. Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand

    Sarah L. Greig & Karly P. Garnock-Jones

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  1. Sarah L. Greig
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  2. Karly P. Garnock-Jones
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Correspondence to Sarah L. Greig.

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The preparation of this review was not supported by any external funding.

Conflict of interest

Sarah Greig and Karly Garnock-Jones are salaried employees of Adis/Springer, are responsible for the article content and declare no relevant conflicts of interest.

Additional information

The manuscript was reviewed by: J. E. Ansell, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA; A. S. Gallus, Department of Haematology, SA Pathology, Flinders Medical Centre, Bedford Park, SA, Australia; A. Gómez-Outes, Agencia Española de Medicamentos y Productos Sanitarios (AEMPS), Madrid, Spain.

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Greig, S.L., Garnock-Jones, K.P. Apixaban: A Review in Venous Thromboembolism. Drugs 76, 1493–1504 (2016). https://doi.org/10.1007/s40265-016-0644-6

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