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Medical Pearls from the Internet Medical Association

Compared with warfarin, factor Xa inhibitors are associated with a lower risk of stroke and other systemic embolic events in patients with atrial fibrillation.

Comment: Factor Xa inhibitors studied included apixaban (Eliquis), betrixaban, darexaban, edoxaban, idraparinux, or rivaroxaban (Xarelto). There are concerns about the inability to readily reverse the effects of these medications. With warfarin, we can give vitamin K to reverse its effects, but there is no current antidote to the factor Xa inhibitors other than time, which is typically 12 to 24 hours. However, in spite of these concerns, the factor Xa inhibitors were associated with lower rates of intracranial hemorrhage and mortality compared with warfarin in patients with atrial fibrillation. I suspect we will see more and more positive findings about this new class of medications. Note: the long-term ( > 2 years ) effect of these medications is not yet well known. From my review of the figure included in this article, there may be a slight advantage to apixaban. Dabigatran (Pradaxa) was not included in this review. It is a direct thrombin (factor IIa) inhibitor.

JAMA. 2014 Mar 19;311(11):1150-1151.    (retrieved Mar, 2014). There are currently 1073 pearls in the database. While every attempt has been made to ensure accuracy, mistakes can and do occur. Use databank at your own risk. All pearls © 2021 by the Internet Medical Association. Click Here to view more medical pearls.