Betrixaban – the next direct factor Xa inhibitor?

ABSTRACT

Introduction: Venous thromboembolism is a major global health burden. Since the 1930s, prevention of stroke and pulmonary embolism in these patients has been achieved using conventional anticoagulants, such as heparin and warfarin. However, in recent years, four direct non-vitamin K antagonist oral anticoagulants (DOACs) have entered the market as alternative treatment options. Betrixaban is a fifth DOAC looking to gain marketing approval in the near future, and may have several potentially beneficial properties.

Areas covered: Here, we outline the metabolism, pharmacokinetics, and pharmacodynamics of betrixaban, and summarise its clinical efficacy and safety based on the results of phase II/III trials.

Expert commentary: Betrixaban has been demonstrated to have antithrombotic activity that may make it a valuable addition to the repertoire of DOACs currently available. The low renal clearance and minimal hepatic metabolism of the drug may make it particularly beneficial for patients with renal or hepatic dysfunction. The lack of an effective reversal agent may be a more significant issue for betrixaban compared with the already approved DOACs as it has a longer terminal half-life. Available data suggest that continued development of betrixaban is justified; however, further large randomised clinical trials are essential in order to clarify its efficacy and safety.

KEYWORDS:

• Betrixaban
• factor Xa inhibitors
• venous thromboembolism
• anticoagulants
• DOAC

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Declaration of Interest

P Bramlage has received research support or consultancy fees from Bayer (the maker of rivaroxaban), Boehringer (dabigatran), Pfizer/Bristol Myers Squibb (apixaban) and Daiichi Sankyo (edoxaban). 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.

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Funding

This paper has not been funded.