Apixaban in the treatment of venous thromboembolism

Abstract:

Traditionally, patients with venous thromboembolic disease (VTE) have been treated with heparin along with the introduction of vitamin K antagonists (VKA). Restrictions on the use of VKA are required for individual dose adjustment, food and drug interactions, and a significant incidence of major bleeding. Nowadays, in accordance with current guidelines, preference is given to new vitamin K-independent oral anticoagulant drugs (NOACs) in the mandatory and prolonged treatment of VTE. The NOAC group includes direct factor Xa inhibitors (apixaban, edoxaban, rivaroxaban) and a direct factor II inhibitor (dabigatran). The factor Xa inhibitors apixaban and rivaroxaban, do not require initial treatment with heparin and thus shorten the time of hospitalization, provide outpatient treatment, i.e. treatment at home, which greatly reduces the cost of care for patients with VTE. The AMPLIFY registration study showed that apixaban in the treatment of acute VTE was non-inferior to conventional therapy with significantly less bleeding (relative risk, RR 0.44). Furthermore, apixaban at a prophylactic dose (2.5 mg twice daily) in prolonged treatment for 12 months of follow-up was more effective in preventing VTE and death compared to placebo (RR 0.33), without an increased risk of major bleeding. Apixaban has been shown to be non-inferior to low molecular weight heparin in the treatment of venous thromboembolism associated with malignancy (CARAVAGGIO study), without an increased risk of major bleeding (hazard ratio 0.82).

Key words:
apixaban; deep vein thrombosis; pulmonary embolism; venous thromboembolic disease