title: The value of inhibitors of factor Xa for the treatment of pulmonary embolism.
abstract: The introduction of factor Xa inhibitors advocated the initiation of clinical trials that addressed the value of anticoagulation in patients with hemodynamically stable primary pulmonary embolism (PE). In the Matisse trial in patients with PE, fondaparinux administered at therapeutic doses followed by vitamin K antagonists (VKA) has shown a comparable efficacy and safety profile to that seen with intravenous adjusted-dose unfractionated heparin/VKA. A long-acting derivative of fondaparinux, idraparinux, failed to achieve similar results. On the other hand, the Cassiopea study revealed that once weekly injections of idrabiotaparinux, a slightly modified form of idraparinux, have similar efficacy and better safety profile compared to VKAs in the long-term treatment of patients with PE. However, the inconvenient parenteral administration of both fondaparinux and idrabiotaparinux limits their routine clinical use. The availability of antithrombotic compounds that can be administered orally in fixed dose, owing to their predictable pharmacokinetics and pharmacodynamics, and have a lower potential for drug and food interactions has opened new horizons for the treatment of patients with PE. The Einstein PE, Amplify and Hokusai studies, conducted with rivaroxaban, apixaban and edoxaban, respectively, showed that for the treatment of PE they possess a more favorable benefit-to-risk profile than the conventional antithrombotic drugs. In addition, rivaroxaban and apixaban make it possible to treat uncomplicated PE patients from the beginning, without the need for the parenteral administration of heparins or fondaparinux, and edoxaban allows the treatment of fragile patients with lower doses. All of them cover a wide spectrum of clinical presentations, including PE patients at intermediate risk.
authors.affiliation: Department of Medicine, Clinica Medica 2, University Hospital of Padova, Via Giustiniani 2, 35128, Padua, Italy, paoloprandoni@tin.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
authors.forename: Sally
authors.initials: S
authors.lastname: Temraz
authors.forename: Sofia
authors.initials: S
authors.lastname: Barbar
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pesavento
authors.forename: Alì
authors.initials: A
authors.lastname: Taher
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000627:therapeutic use*; D000077425:Fondaparinux; D006801:Humans; D011134:Polysaccharides / Q000627:therapeutic use; D011655:Pulmonary Embolism / Q000188:drug therapy*; D000069552:Rivaroxaban / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011134:Polysaccharides; D000069552:Rivaroxaban; D000077425:Fondaparinux