title: Novel Oral Anticoagulants in Atrial Fibrillation: Update on Apixaban.
abstract: Almost 800,000 new or recurrent strokes occur every year. Atrial fibrillation, the most common cardiac arrhythmia, is a major risk factor for stroke, accounting for 15-20% of ischemic strokes. Apixaban is a direct inhibitor of Factor Xa that was approved in December 2012 by the US Food and Drug Administration (FDA) for the prevention of stroke in patients with non-valvular atrial fibrillation. It is part of a family of novel oral anticoagulants (NOACs) which has advantage over warfarin of less dosing variability, rapid onset of action and no INR monitoring required. Apixaban showed superiority to warfarin in both primary efficacy and primary safety outcomes by simultaneously showing both significantly lower rates of strokes and systemic embolism and a reduced risk of major clinical bleeding in clinical trials. Warfarin remains the anticoagulant of choice for patients with prosthetic heart valves and significant mitral stenosis. There are currently no head-to-head studies that directly compare the different NOACs with one another, but it is expected that there will be more trials in the future that will explore this comparison. Dabigatran is the only NOAC with an FDA approved reversal agent. However, a reversal agent for apixaban is being developed and was successful in recent clinical trials. This review summarizes the clinical trial data on apixaban for atrial fibrillation, compares apixaban to other NOACs and discusses apixaban use in clinical practice.
authors.affiliation: Department of Medicine, Einstein Medical Center Philadelphia, 5501 Old York Rd, Philadelphia, PA 19141, USA.
authors.forename: Kenechukwu
authors.initials: K
authors.lastname: Mezue
authors.forename: Chukwudi
authors.initials: C
authors.lastname: Obiagwu
authors.forename: Jinu
authors.initials: J
authors.lastname: John
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.forename: Felix
authors.initials: F
authors.lastname: Yang
authors.forename: Jacob
authors.initials: J
authors.lastname: Shani
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D004617:Embolism / Q000517:prevention & control; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D011728:Pyridones / Q000008:administration & dosage / Q000627:therapeutic use*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology
chemical_list: D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban