Abstract
Review summarizes clinical pharmacology,pharmacokinetics,efficacy,safety of and clinical experience with apixaban.Apixaban is a novel oral anticoagulant with a rapid onset of action and a mechanism of direct,selective inhibition of coagulation factor Xa.The results of ADVANCE trials have shown that apixaban is comparable to or more effective than low-molecular-weight heparin enoxaparin in preventing venous thromboembolic events in patients who underwent total knee or hip replacement,with a similar or lower risk of bleeding.Other large clinical trials confirmed that apixaban was significantly more effective than acetylsalicylic acid(AVERROES trial) or warfarin(ARISTOTLE trial) in preventing stroke and systemic thromboembolic events in patients with atrial fibrillation,with a safety similar to that of acetylsalicylic acid and with a significantly superior safety profile in comparison with warfarin.In AMPLIFY trial,a simple treatment regimen with a fixed dose of apixaban was shown to be as effective in treating acute venous thromboembolism as conventional treatment with low-molecular-weight heparin followed by long-term warfarinization,but was associated with a significantly lower risk of bleeding.APPRAISE-2 trial that evaluated the addition of apixaban to antiplatelet therapy in the secondary prevention of ischaemic events after having an acute coronary syndrome was terminated early due to inefficacy and a clinically significant increase in the risk of bleeding.In conclusion,the new oral anticoagulant apixaban has an efficacy and safety comparable to that of enoxaparin in terms of preventing venous thromboembolic events following major orthopaedic surgery,while having a benefit of being administered orally.The same applies to the treatment and secondary prevention of acute venous thromboembolism.In patients with atrial fibrillation,apixaban is more effective than warfarin in preventing stroke and systemic embolism and has a significantly lower risk of bleeding.