USMLE

Factor Xa Inhibitors (Rivaroxaban, Apixaban)

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Hematology Drugs
  1. Dabigatran / Argatroban
  2. Factor Xa Inhibitors (Rivaroxaban, Apixaban)
  3. Heparin
  4. Low Molecular Weight Heparins (Enoxaparin, Fondaparinux, Dalteparin)
  5. Warfarin
  6. Aspirin
  7. GPIIb/IIIa Inhibitors (Abciximab, Tirofiban, Eptifibatide)
  8. Alteplase / tPA
  9. Iron
  10. Filgrastim
  11. Epoetin Alfa

Summary

Factor Xa Inhibitors are a group of drugs easily recognizable by their -xaban endings, like apixaban, rivaroxaban, and edoxaban. Factor Xa inhibitors are blood thinners, meaning they are used to prevent blood clots from forming, helping to treat people who suffer from deep vein thrombosis, pulmonary embolism, or atrial fibrillation. As an anticoagulant, these drugs have the side effect of increasing the risk of bleeding.

Key Points

  • Drug Names
    • Rivaroxaban (Xarelto)
    • Apixaban (Eliquis)
    • Edoxaban (Savaysa)
    • Mechanism
      • Anticoagulant
        • Blocks clotting factor Xa and thus inhibiting clot formation
      • Routine monitoring of clotting (PTT, INR/PT) is not necessary, as these medications reach stable therapeutic levels at recommended doses
    • Clinical Use
      • Prevention of blood clots
        • Deep Vein Thrombosis (DVT)
        • Pulmonary Embolism (PE)
        • Atrial fibrillation
          • With a fib, blood is not effectively flowing through the heart, and pooled blood in the atria increases the risk of clot formation
    • Side Effects and Adverse Reactions
      • Bleeding
        • Risk of bleeding is lower than other oral anticoagulants (heparin, warfarin, etc.) and therefore factor Xa inhibitors do not require clotting time monitoring
        • Avoid other medications that increase the risk of bleeding, like NSAIDS
      • In patients with renal impairment, the dose should be reduced