A novel anticoagulant

Apixaban reduces risk for nonvalvular AF-related strokes


APIXABAN, considered a novel anticoagulant that can be another alternative to warfarin, has been recently launched in the country.

In a press briefing, Dr. Maria Cristina San Jose, president of the Stroke Society of the Philippines, said that for the longest time, we only had warfarin as an option. She added that warfarin is underutilized in clinical practice.

“It’s because the patients would need to do a blood test (protime),” said Dr. San Jose. However, its cost and availability in hospitals particularly in the provinces is a major problem, she explained. “But because of lack of choice, patients are prescribed with it (warfarin),” she said.

Apixaban is an oral, fixed-dose anticoagulant that does not require protime monitoring as required with warfarin usage for dose titration. It also has less food interaction and is associated with less major bleeding than warfarin.

Dr. San Jose said that apixaban helps in reducing strokes due to atrial fibrillation (AF), so long as there are no significant valvular problems in the patient. Experts would still recommend warfarin for valvular cases with AF.

AF occurs more frequently in older people, said Dr. Gregory Flaker of the University of Missouri. In a study involving 5,000 patients comparing the efficacy and safety of apixaban versus warfarin, there was a 55 percent reduction in ischemic stroke with apixaban.

“The risk of stroke was not eliminated, but was substantially reduced,” he said.

Violy Remo, Pfizer Inc. (Philippines) country manager said that apixaban was introduced last year as a preventive measure against venous thromboembolism in patients who have undergone elective hip or knee placement surgery. Now, he said that this drug has been proven to reduce stroke risk among patients with non-valvular AF.

Dr. Flaker noted that apixaban’s main side effect is bleeding but its incidence is less compared to warfarin.

“Doctors tend to blame themselves for bleeding,” he said, and added that sometimes, the doctors think they’ve been negligent in taking the necessary precautions to prevent bleeding.

Novel anticoagulants such as apixaban offer the advantage of safety in causing less major bleeding, while at the same time being at least equally effective as warfarin in preventing AF-related strokes and systemic embolism.

Two other novel anticoagulants—dabigatran and rivaroxaban—have been introduced earlier into the local market.

VitalSigns Issue 68 Vol. 3, October 1-31, 2014

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