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High potential for food interactions
2%
38/1660
Maximal anticoagulant effect achieved 2-4 hours after administration
37%
619/1660
Only available for IV and subcutaneous administration
3%
49/1660
Requires periodic coagulation monitoring
4%
64/1660
Metabolized primarily through kidneys
53%
885/1660
Select Answer to see Preferred Response
Factor Xa inhibitors such as apixaban and rivaroxaban are a new class of anticoagulants that can be taken orally and have a quick onset, 2-4 hours to reach maximal effectiveness. Xabans, as they are collectively referred, are a new group of anticoagulants that work through direct inhibition of Factor Xa. These medications all demonstrate rapid onset of action, a low potential for food and drug interactions, and a predictable anticoagulant effect that negates the need for routine coagulation monitoring. Additionally, xabans are administered orally, so there is no need for needles or injections. Excretion occurs through numerous pathways including the liver (major), kidneys, and intestines. The biggest risk factor with this class of anticoagulants is bleeding, however, the FDA has recently approved a coagulation factor Xa [recombinant] inactivated-zhzo to reverse anticoagulation effects of factor Xa inhibitors in the setting of life-threatening or uncontrolled bleeding. Eriksson et al review the use of novel oral factor Xa and thrombin inhibitors in the management of thromboembolisms. They highlight the fact that these medications have rapid onset, low potential for interactions, and a predictable anticoagulation profile. They report that rivaroxaban is approved internationally for the prevention of venous thromboembolisms in patients undergoing elective THA and TKA. They conclude that the superior pharmacological properties and convenience of this new class of medication has led to improved efficacy and safety. Venker et al review the safety and efficacy of new anticoagulants for the prevention of venous thromboembolisms after hip and knee arthroplasties. They report that compared to enoxaparin 40mg daily, apixaban, rivaroxaban, fondaparinux and edoxaban reduced the rate of VTE after arthroplasty. They conclude, however, that while newer anticoagulants decreased the overall rate of VTE, they also increased the risk of postoperative bleeding. Illustration A demonstrates the coagulation cascade and where numerous anticoagulants act. Incorrect Answers: Answer 1: Vitamin K antagonists such as warfarin have many food and drug interactions, not xabans Answer 3: Factor Xa inhibitors are administered orally, a major advantage compared to other anticoagulants Answer 4: Factor Xa inhibitors do not require regular coagulation monitoring as is done with vitamin K antagonists Answer 5: Excretion occurs through multiple pathways within the liver and renal systems
3.0
(5)
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