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APIXABAN
The second factor Xa (after rivaroxaban) to be approved in the United States is apixaban (Eliquis; Bristol-Myers Squibb/ Pfizer). The clinical trials with apixaban have revealed less renal excretion than with dabigatran or rivaroxaban; unlike warfarin it has no food interactions, but as with the other factor Xa inhibitors, apixaban has P-glycoprotein and CYP3A4 interactions. Unlike rivaroxaban, however, apixaban requires twice-daily (bid) dosing.
As shown in the Figure, the 2 pivotal trials with this drug have been AVERROES[97] and ARISTOTLE.[98] In AVERROES, apixaban was clearly superior to aspirin; however since current guidelines already mandate that antiplatelet therapy is insufficient in patients with a CHA2DS2-Vasc score ≥1, those results are not important for this presentation. ARISTOTLE was a comparison of apixaban versus warfarin, which is important because that allows indirect comparison with ROCKET AF trial (with rivaroxaban)[[97] and the RE-LY trial (with dabigatran).[96]
Reiffel JA. Am J Med 2013; 126: 00-00.
[96] Connolly SJ, Ezekowitz MD, Yusuf S, et al; RE-LY Steering Committee and Investigators. Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med. 2009;361:1139-1151.
[97] Patel MR, Mahaffey KW, Garg J, et al; the ROCKET AF Steering Committee, for the ROCKET AF Investigators. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med. 2011;365:883-891.
[98] Connolly SJ, Eikelboom J, Joyner C, et al; AVERROES Steering Committee and Investigators. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011;364:806-817.
[99] Granger CB, Alexander JH, McMurray JV, et al; the ARISTOTLE Committees and Investigators. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011;365:981-992.