From the Guidelines
Apixaban is a direct oral anticoagulant (DOAC) that belongs to the factor Xa inhibitor class of medications. This classification is based on the most recent and highest quality study available, which provides an updated recommendation on the nomenclature for anticoagulants 1. The study, published in 2023, confirms that apixaban is a factor Xa inhibitor, a class of medications that work by selectively blocking factor Xa, a key enzyme in the blood clotting cascade.
Key Characteristics of Apixaban
- Apixaban is commonly marketed under the brand name Eliquis and is used to prevent stroke and systemic embolism in patients with non-valvular atrial fibrillation, to treat deep vein thrombosis (DVT) and pulmonary embolism (PE), and to prevent recurrent DVT and PE.
- The standard dosing is typically 5 mg twice daily, though a reduced dose of 2.5 mg twice daily is recommended for patients meeting certain criteria such as advanced age (≥80 years), low body weight (≤60 kg), or elevated serum creatinine (≥1.5 mg/dL) 1.
- Unlike traditional anticoagulants like warfarin, apixaban does not require routine blood monitoring and has fewer food and drug interactions, making it more convenient for patients.
- However, it's essential to note that apixaban should be used cautiously in patients with severe renal impairment and is contraindicated in those with active pathological bleeding.
Clinical Evidence
The classification of apixaban as a factor Xa inhibitor is supported by multiple studies, including a 2016 study published in the Journal of Thrombosis and Haemostasis, which discusses the use of antidotes for the reversal of direct oral anticoagulants, including apixaban 1. Additionally, a 2013 study published in the Journal of the National Comprehensive Cancer Network provides information on the use of apixaban for thromboprophylaxis and treatment of venous thromboembolism 1. However, the most recent and highest quality study, published in 2023, provides the most up-to-date information on the classification of apixaban as a factor Xa inhibitor 1.
From the FDA Drug Label
Apixaban, a factor Xa (FXa) inhibitor, is chemically described as 1-(4- methoxyphenyl)-7-oxo-6-[4-(2-oxopiperidin-1-yl)phenyl]-4,5,6,7-tetrahydro-1H-pyrazolo[3,4 c]pyridine-3-carboxamide. Apixaban is a selective inhibitor of FXa. It does not require antithrombin III for antithrombotic activity. Apixaban inhibits free and clot-bound FXa, and prothrombinase activity.
The drug class of Apixaban is a Direct Oral Anticoagulant (DOAC), specifically a factor Xa inhibitor 2.
From the Research
Drug Class of Apixaban
The drug class of Apixaban is a Direct Oral Anticoagulant (DOAC) [ 3, 4, 5, 6, 7 ].
Characteristics of Apixaban
- Apixaban is a highly selective, reversible, direct factor Xa inhibitor [ 3 ]
- It inhibits both free factor Xa and prothrombinase activity, and clot-bound factor Xa activity [ 3 ]
- Apixaban has a predictable pharmacokinetic profile, multiple pathways of elimination, an improved bleeding profile relative to warfarin with a lack of other significant adverse events, and no need for routine anticoagulation monitoring [ 3 ]
Comparison with Other Anticoagulants
- Apixaban is more effective than either warfarin or aspirin for stroke prevention, with an acceptable safety profile [ 5 ]
- Apixaban has a lower rate of both ischemic stroke or systemic embolism and bleeding compared with rivaroxaban [ 7 ]