CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

March 4th, 2010

Thursday, March 4 News: Apixaban Advances

Apixaban, a new factor Xa inhibitor under development, was compared with enoxaparin for thromboprophylaxis following knee replacement surgery in the ADVANCE-2 trial. The new report appears in the Lancet. In the primary efficacy analysis, the primary outcome — the composite of asymptomatic and symptomatic deep vein thrombosis, nonfatal pulmonary embolism, and all-cause death during treatment — was reached in 15% of apixaban patients compared with 24% of enoxaparin patients, a highly significant difference. Major or other clinically relevant bleeding was reported in 4% of the apixaban group versus 5% of the enoxaparin group. 
    In an accompanying comment, Jawed Fareed and Russell Hull note that in the previously published ADVANCE-1 trial, apixaban did not demonstrate noninferiority when compared to a different enoxaparin regimen, although it was associated with a lower bleeding rate. (ADVANCE-2 used the enoxaparin regimen most commonly employed outside the U.S.; ADVANCE-1 used the standard U.S. regimen.) The editorialists write that ADVANCE-2 brings us “potentially a step closer to the unmet need of oral antithrombotic therapy without need for monitoring.” Other new agents, including rivaroxaban and dabigatran, may also fill this need, they say.

Categories: General


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