He was joined by Prof Barry Jacobson, President of the Southern African Society of Thrombosis and Haemostasis, and Head of Clinical Haematology at the National Health Laboratory Service. This CPD activity was made possible by Zydus.

Apixaban is a non-vitamin K oral anticoagulant (NOAC) used for managing venous thromboembolism (VTE) and non-valvular AFib. As an anti-factor Xa inhibitor, it targets the coagulation cascade, offering an alternative to traditional vitamin K antagonists (VKAs) and heparins.

Apixaban inhibits factor Xa, crucial for thrombin generation. Unlike vitamin K antagonists, it does not require frequent monitoring and has fewer food interactions. It is rapidly absorbed with a bioavailability of 50% and a half-life of about 12 hours. Apixaban’s use in VTE includes treatment of deep vein thrombosis and pulmonary embolism, and in AFib, it helps prevent stroke.

The standard dosage for apixaban is 5mg twice daily, adjustable to 2.5mg twice daily for patients >80-years or with specific health conditions. Monitoring of anti-factor Xa levels can be useful, especially in special populations, although routine monitoring is generally not required. Specific tests for apixaban should be calibrated for its unique properties.

Studies show that apixaban is effective and generally safer compared to VKAs. The Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial demonstrated apixaban’s superiority in stroke prevention with a lower risk of bleeding and mortality. Additionally, it has shown non-inferiority to conventional therapy in treating VTE and lower bleeding rates.

Apixaban is metabolised by the liver (CYP3A4 system) and minimally excreted by the kidneys. It has a high safety profile in patients with mild to moderate renal impairment, though it is not recommended for those with severe renal dysfunction.

Drug interactions include CYP3A4 and P-glycoprotein inhibitors and inducers, which can affect apixaban levels. It is crucial to adjust doses based on these interactions and patient-specific factors.

The introduction of apixaban generics has increased accessibility, though their efficacy must be confirmed through ongoing research. A recent study of a generic apixaban confirmed its effectiveness in treating patients in a real-world setting, showing comparable anti-factor Xa levels to the branded drug.

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