Apixaban

Products

Apixaban has been approved in many countries since 2011 in the form of film-coated tablets (Eliquis).

Structure and properties

Apixaban (C25H25N5O4, Mr = 460.0 g/mol) was developed starting from razaxaban. It is an oxopiperidine and pyrazole derivative.

Effects

Apixaban (ATC B01AF02) has antithrombotic properties. It is an oral, direct, potent, selective, and reversible inhibitor of factor Xa, which plays a central role in the blood clotting cascade. Factor Xa is a serine protease formed from factor X in both the intrinsic and extrinsic pathways and catalyzes the formation of thrombin from prothrombin. Thrombin converts fibrinogen to fibrin, promoting the formation of the fibrin plug. By inhibiting Xa, apixaban prevents thrombus formation. Apixaban binds L-shaped to the active site of factor Xa (PDB 2P16):

Indications

Dosage

According to the drug label. Apixaban is taken twice daily (morning and evening), independent of meals.

Contraindications

  • Hypersensitivity
  • Clinically relevant acute bleeding
  • Liver disease associated with coagulopathy and clinically relevant bleeding risk, severe liver failure

Full precautions can be found in the drug label.

Interactions

Apixaban is metabolized primarily by CYP3A4/5 and is a substrate of P-gp and BCRP. Corresponding interactions are possible. Additive effects have been observed in combination with enoxaparin. Combination with other anticoagulants must be done with caution.

Adverse Effects

The most common potential adverse effects include hemoptysis, bleeding, bruising, and nausea. Andexanet alfa is available as an antidote.