Pharmacotherapy with oral Xa inhibitors for venous thromboembolism

Abstract

Introduction: Venous thromboembolism (VTE) causes substantial morbidity and mortality worldwide. The traditional treatment of VTE, with an initial therapy with (low molecular weight) heparin or fondaparinux and a continued treatment with vitamin K antagonists, is effective but has limitations.

Areas covered: The current review summarizes the results of the Phase III trials with the new oral direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban and provides a meta-analysis of these trials in the subgroups of elderly patients (> 75 years) and patients with impaired renal function.

Expert opinion: The practical use of direct Xa inhibitors in the treatment of VTE in general and in specific subgroups is discussed. For elderly patients, patients with extremes of body weight, cancer patients or patients with moderate renal impairment, pooled data suggest that the direct oral Xa inhibitors are a reasonable alternative to standard therapy. For other indications, such as treatment of VTE in children, during pregnancy or in the context of heparin-induced thrombocytopenia, further data from clinical trials are needed.

Keywords:

• apixaban
• deep vein thrombosis
• edoxaban
• factor X
• oral anticoagulants
• pulmonary embolism
• rivaroxaban
• venous thromboembolism

Declaration of interest

K Peerlinck received research support from Bayer, Baxter, CSL Behring and Pfizer. P Verhamme received honorarium for lectures or advisory boards from Boehringer-Ingelheim, Daiichi-Sankyo, Bayer and Pfizer, and research support from Boehringer-Ingelheim, Bayer and Sanofi. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Notes

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