title: [Proper use of apixaban: an outline for clinical practice].
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.
authors.affiliation: Service d'anesthésie-réanimation, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
authors.forename: P
authors.initials: P
authors.lastname: Albaladejo
authors.affiliation: Laboratoire de pharmacologie, faculté de médecine, CHR de Lille, 1, place de Verdun, 59045 Lille, France.
authors.forename: D
authors.initials: D
authors.lastname: Deplanque
authors.affiliation: 12, rue de Condé, 59110 La Madeleine, France.
authors.forename: F
authors.initials: F
authors.lastname: Fossati
authors.affiliation: Unité neurovasculaire, hôpital Saint-Roch, CHU de Nice, 5, rue Pierre-Devoluy, BP 319, 06006 Nice cedex 1, France.
authors.forename: M H
authors.initials: MH
authors.lastname: Mahagne
authors.affiliation: Service médecine et thérapeutique, hôpital Bellevue, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: P
authors.initials: P
authors.lastname: Mismetti
authors.affiliation: Laboratoire central d'hématologie, hôpital Robert-Debré, CHU de Reims, avenue du Général-Koenig, 51092 Reims cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Nguyen
authors.affiliation: Accueil et traitement urgences, CHU d'Angers, 4, rue Larrey, 49933 Angers cedex 9, France.
authors.forename: P
authors.initials: P
authors.lastname: Roy
authors.affiliation: Service de neurologie, hôpital Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Touze
authors.affiliation: Unité médecine interne, HTA, hôpital Avicenne-AP-HP, 125, rue de Stalingrad, 93009 Bobigny cedex, France. Electronic address: jean-jacques.mourad@avc.aphp.fr.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Mourad
mesh_terms: D000818:Animals; D000925:Anticoagulants; D001281:Atrial Fibrillation / Q000150:complications; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D004347:Drug Interactions; D004617:Embolism / Q000517:prevention & control; D065427:Factor Xa Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D005602:France; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011728:Pyridones / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D020521:Stroke / Q000517:prevention & control; D054556:Venous Thromboembolism / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban
keywords: Anticoagulants oraux directs; Apixaban; Bon usage; Direct oral anticoagulants; Proper use