From the Guidelines
Apixaban belongs to the direct oral anticoagulant (DOAC) class, which includes several other medications that work similarly, such as rivaroxaban, edoxaban, and betrixaban, as well as dabigatran, which is a direct thrombin inhibitor. These medications are used to prevent blood clots in conditions such as atrial fibrillation, deep vein thrombosis, and pulmonary embolism. The most recent and highest quality study, published in 2024 1, supports the use of DOACs, including apixaban, as a class of medications that have demonstrated at least non-inferior efficacy compared with warfarin for the prevention of thromboembolism, but with the added benefit of a 50% reduction in intracranial haemorrhage.
- Key characteristics of DOACs include:
- Targeting a specific factor in the coagulation pathway, either FXa or FIIa
- More predictable pharmacokinetic and pharmacodynamic properties compared to vitamin K antagonists (VKAs) like warfarin
- No requirement for routine monitoring of the anticoagulant effect
- Fewer food-drug interactions compared to VKAs
- However, DOACs still carry bleeding risks and require appropriate dosing based on kidney function, age, and weight, as noted in a study from 2021 1.
- Some DOACs need to be taken with food for optimal absorption, and patients should be aware that sudden discontinuation can increase clotting risk, as discussed in a study from 2016 1.
- If switching between anticoagulants, proper transition protocols should be followed to maintain effective anticoagulation throughout the process, as recommended in a study from 2023 1.
From the Research
Medications in the Same Class as Apixaban
Medications in the same class as apixaban, a direct oral anticoagulant (DOAC), include:
- Rivaroxaban
- Edoxaban
- Dabigatran
- Betrixaban
Characteristics of DOACs
These medications share similar pharmacological properties, such as:
- Fixed doses without the need for therapeutic drug monitoring
- Inhibition of factor Xa (apixaban, edoxaban, rivaroxaban, and betrixaban) or factor IIa (dabigatran)
- Metabolism mediated by CYP3A4 for the anti-Xa inhibitors
- Short half-life with variable rates of renal elimination
- Transportation by P-glycoprotein 2, 3, 4
Clinical Uses and Comparisons
DOACs are used to prevent thromboembolic events in patients with atrial fibrillation and other conditions, and have been compared in various studies:
- A multinational population-based cohort study found that apixaban was associated with a lower risk of gastrointestinal bleeding compared to dabigatran, edoxaban, and rivaroxaban 5
- A systematic review and meta-analysis found that DOACs decreased the risk of all-cause bleeding, stroke, and systemic embolization compared to vitamin K antagonists 6
- Laboratory measurements of DOACs can be performed using various assays, including calibrated chromogenic anti-FXa assays and ecarin-based assays 3, 4