Apixaban is a reversible, direct, selective inhibitor of factor Xa. It inhibits free and clot-bound factor Xa and prothrombinase, preventing thrombin formation and clot development. Patients receiving apixaban do not require anticoagulation monitoring during treatment.1
Two pivotal, phase 3, double-blind studies compared the thromboprophylactic efficacy of apixaban against the low molecular weight heparin, enoxaparin, following major joint replacement: the ADVANCE-2 study recruited 3057 patients undergoing knee replacement and the ADVANCE-3 study investigated 5407 patients requiring hip replacement.2,3
In both studies, patients were randomised to receive either oral apixaban 2.5mg twice daily starting 12–24 hours after surgery or subcutaneous enoxaparin 40mg once daily starting 12 hours before surgery. Both drugs were continued for 10–14 days following knee surgery or 35 days following hip replacement. The primary endpoint used was a composite of total venous thromboembolic events and all-cause mortality.2,3
Apixaban displayed superior efficacy to enoxaparin in reducing incidence of the primary endpoint in the ADVANCE-2 study (15% vs 24%; relative risk 0.62, 95% CI 0.51-0.74; p<0.0001) and in the ADVANCE-3 study (1.39% vs 3.86%; relative risk 0.36, 95% CI 0.22-0.54; p<0.0001).2,3
Rates of clinically relevant non-major haemorrhage were comparable between the apixaban and enoxaparin groups in both studies. The side-effects most frequently observed with apixaban use are bleeding, anaemia, contusion and nausea.1
1. Eliquis Summary of Product Characteristics, 2011.
2. Lassen MR et al. Lancet 2010; 375: 807-15.
3. Lassen MR et al. N Engl J Med 2010; 363: 2487–98.
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Further information: BMS
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