There is a lot of appropriate interest and excitement today about one of the four new blood thinners in development – Apixaban (Eliquis). Data from the large atrial fibrillation trial called ARISTOTLE were published today and show that the drug is more effective and safer than warfarin in patients with atrial fibrillation [ref 1]. This is good news.The results and publication have, however, no immediate impact on patients and clinicians. The drug still needs to go through the FDA approval process and then become available through pharmacies. In addition, the trial comparing Apixaban to warfarin for patients with DVT and/or PE – the AMPLIFY trial – is still ongoing (see table 1 here).
Atrial Fibrillation
Atrial fibrillation, a type of irregular heart beat, puts patients at risk for blood clot formation in one of the chambers of the heart. From there a clot can break off and travel through the arteries to the brain, causing a stroke. It may also travel to the arteries of the extremities or abdomen, causing a peripheral arterial thromboembolism. The medical issues for patients with atrial fibrillation are very different to those of patients with DVT/PE. However, both conditions have in common that they are presently often treated with warfarin (Coumadin, Jantoven) to prevent clots from forming. The new oral blood thinners in development are, therefore, potentially useful for patients with atrial fibrillation and those with DVT and/or PE. Thus, any report of good efficacy and safety of the new drugs in patients with atrial fibrillation are positive news for patients with DVT/PE as well.
The New Blood Thinners
The four new oral drugs of relevance are (a) Pradaxa (Dabigatran), (b) Xarelto (Rivaroxaban), (c) Eliquis (Apixaban), and (d) Edoxaban (Lixiana). Clinical-practical relevant information on these drugs is discussed in other Clot Connect blogs. A summarizing table can be found here (see table 1 here). The reader interested in atrial fibrillation can find relevant information in non-Clot Connect resources that focus specifically on atrial fibrillation. A more detailed discussion of today’s Eliquis (Apixaban) clinical trial results as it relates to atrial fibrillation can be found here. The full article is available in the New England Journal of Medicine [ref 1].
References
1. Granger CB et al. N Engl J Med, Aug 29 2011 (ePub ahead of print).
Disclosure: I have consulted for OthoMcNeil and Bayer, the companies developing Xarelto.
Last updated: Aug 28th, 2011
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4 responses to “Eliquis (Apixaban) News – Plus Update On The Big Four New Oral Anticoagulants”
How soon is the new drug gonna be available for patients? I am on coumadin for life and would love, love a drug that doesn’t need constant monitoring? I am going to get blood work..every 2 weeks now? Thanks!
(a) Pradaxa: Paradaxa is already available. The FDA-approved indication is for atrial fibrillation, but Pradaxa can be used off label for secondary DVT and PE prevention – for a discussion see: https://clotconnect.wordpress.com/2010/10/27/dabigatran-approval-–-great-news.
(b) Xarelto: I estimate that Xarelto and Eliquis (FDA indication: atrial fibrillation) may become available in 6-12 months, i.e. first half to middle of 2012. Again, as a DVT/PE treatment trial has been completed and published with Xarelto, the drug could be used off label for DVT and PE patients at that time.
(c) Apixaban: If Apixaban becomes available in 2012, I would still wait with off label use in DVT and PE patients until the Apixaban DVT/PE treatment trial still has been completed and published.
It would be nice to know its effect in Europe.
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