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Albaladejo P, Deplanque D, Fossati F, Mahagne MH, Mismetti P, Nguyen P, Roy P, Touze E, Mourad JJ. [Proper use of apixaban: an outline for clinical practice]. ACTA ACUST UNITED AC 2014; 39:409-25. [PMID: 25451020 DOI: 10.1016/j.jmv.2014.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 09/10/2014] [Indexed: 12/18/2022]
Abstract
Apixaban is a direct inhibitor of coagulation factor Xa. Superior efficacy over aspirin and antivitamin K has been shown in the prevention of stroke and systemic embolism during non-valvular atrial fibrillation with a more favorable safety profile, even though the risk of hemorrhage cannot be ignored, considering its mechanism of action. The recommended dose is 5mg twice daily which can be reduced to 2.5mg depending on the individual risk. Apixaban is also indicated for the treatment of venous thromboembolism but reimbursement has not yet been accepted in France for this indication. As with all direct oral anticoagulants, no routine biological monitoring is required, nevertheless their use may have an impact on all coagulation tests, eventually hampering interpretation. In particular clinical circumstances where a measure of anticoagulant efficacy is deemed necessary, specific assay of anti-Xa activity is appropriate, the result being expressed as concentration of the anticoagulant used. It is therefore necessary to state the name of the medicine for which the assay is requested. With these new anticoagulants, management of hemorrhagic events can be more difficult due to the lack of a specific antidote. Pro-hemostatic substances have exhibited efficacy in animal models but results are still insufficiently documented in clinical practice. Local or locoregional hemostasis measurements, when possible, are an essential factor in the treatment of hemorrhagic events.
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Affiliation(s)
- P Albaladejo
- Service d'anesthésie-réanimation, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - D Deplanque
- Laboratoire de pharmacologie, faculté de médecine, CHR de Lille, 1, place de Verdun, 59045 Lille, France
| | - F Fossati
- 12, rue de Condé, 59110 La Madeleine, France
| | - M H Mahagne
- Unité neurovasculaire, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Devoluy, BP 319, 06006 Nice cedex 1, France
| | - P Mismetti
- Service médecine et thérapeutique, hôpital Bellevue, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France
| | - P Nguyen
- Laboratoire central d'hématologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France
| | - P Roy
- Accueil et traitement urgences, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France
| | - E Touze
- Service de neurologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France
| | - J-J Mourad
- Unité médecine interne, HTA, hôpital Avicenne-AP-HP, 125, rue de Stalingrad, 93009 Bobigny cedex, France.
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Abstract
New oral factor Xa inhibitors are intended to progressively substitute the oral vitamin K antagonists and parenteral indirect inhibitors of factor Xa in the prevention and treatment of venous and arterial thromboembolic episodes. This article focuses on the main clinical studies and on biological measurements of new oral factor Xa inhibitors, and addresses several safety issues. These newer agents do not require any routine laboratory monitoring of blood coagulation; however, biological tests have been developed in order to assess the plasma concentration of these drugs in several clinical settings. This article reviews these 4 oral direct factor Xa inhibitors.
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Affiliation(s)
- Meyer Michel Samama
- Department of Biological Hematology, Cochin Hôtel-Dieu University Hospitals, 27 rue du Faubourg St-Jacques, Paris 75014, France; BIOMNIS Laboratories, 78 Avenue de Verdun, Ivry-sur-Seine 94200, France
| | - Sadia Meddahi
- Department of Biological Hematology, Cochin Hôtel-Dieu University Hospitals, 27 rue du Faubourg St-Jacques, Paris 75014, France; BIOMNIS Laboratories, 78 Avenue de Verdun, Ivry-sur-Seine 94200, France
| | - Charles Marc Samama
- Department of Anesthesia and Intensive Care Medicine, Cochin Hôtel-Dieu University Hospitals, 27 rue du Faubourg St-Jacques, Paris 75014, France.
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Meddahi S, Samama MM. Caractéristiques pharmacologiques et cliniques des inhibiteurs directs du facteur Xa : rivaroxaban, apixaban, edoxaban et betrixaban. ACTA ACUST UNITED AC 2014; 39:183-94. [DOI: 10.1016/j.jmv.2014.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 01/21/2014] [Indexed: 12/31/2022]
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