Hematology and Oncology Book

Tranfusion

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Factor Xa Inhibitor

Aka: Factor Xa Inhibitor, FXa Inhibitor, Direct Factor Xa Inhibitors
  1. See Also
    1. Anticoagulants
    2. Clotting Pathway
  2. Class
    1. Direct Factor Xa Inhibitor
    2. Factor Xa is the first step in the Common Clotting Cascade
  3. Mechanism: Based on naturally occurring substances
    1. Antistasin
      1. Isolated in 1980s from Mexican leach extract
    2. Tick Anticoagulant peptide (TAP)
      1. Isolated from the tick Ornithodoros moubata
  4. Preparations
    1. Rivaroxaban (Xarelto)
      1. Anticoagulation in Venous Thromboembolism (especially in Deep Vein Thromboembolism)
      2. Anticoagulation in Atrial Fibrillation
        1. Oral Anticoagulant for Atrial Fibrillation as a second line alternative to Warfarin or Dabigatran (Pradaxa)
        2. Bridging to Transesophageal Echocardiogram and early cardioversion in Atrial Fibrillation (ideal indication)
    2. Apixaban (Eliquis)
      1. Oral anticoagluant for Atrial Fibrillation (released in United States in 2013)
      2. Appears more effective than Warfarin with less risk of bleeding
        1. Prevents 3 more strokes per 1000 patients per year than Warfarin
        2. Complications are less than Warfarin
          1. Bleeding complications: 10 per 1000 fewer than warfain each year
          2. Deaths: 4 per 1000 fewer than Warfarin each year
      3. References
        1. Mohammed (2012) J Cardiovasc Med 13(2):73-85 [PubMed]
    3. Fondaparinux (Arixtra)
    4. Betrixaban
    5. Edoxaban (Savaysa)
    6. Otamixaban
  5. Management: Reversal
    1. Stop offending Xa agent
    2. Consider Activated Charcoal if presenting within 2 hours of suspected Overdose ingestion
    3. Bleeding unlikely due to Xa agent if Anti-Xa level <0.1 IU/ml
    4. Dialysis is not effective (protein bound)
    5. For serious bleeding (e.g. CNS Hemorrhage following Head Trauma)
      1. See Emergent Reversal of Anticoagulation
      2. Specific antidote pending approval in U.S. (all other recommendations per expert opinion)
        1. No human data to suggest any non-specific reversal agent is significantly effective
    6. References
      1. Deloughery and Orman in Majoewsky (2013) EM:Rap 13(9): 1
      2. Sun (2016) Crit Dec Emerg Med 30(8): 28
  6. Management: Other bleeding complications
    1. Menorrhagia
      1. Expect Menses to be heavier than typical while on Factor Xa Inhibitors
      2. However, severe Menstrual Bleeding on Factor Xa Inhibitors is uncommon
      3. Patients should seek medical attention for 4 soaked pads in 4 hours or more than 10 pads in 24 hours
        1. Consider holding Factor Xa Inhibitor for one day and then restarting at same dose
      4. References
        1. Orman and Klein in Herbert (2017) EM:Rap 17(7): 9-11

Direct Factor Xa Inhibitors (C3653500)

Concepts Pharmacologic Substance (T121)
MSH D065427
LNC LP175669-3
English Direct factor Xa inhibitors, Direct Factor Xa inhibitors, Direct Factor Xa Inhibitors
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Factor Xa inhibitors (C3669283)

Definition (MSH) Endogenous factors and drugs that inhibit or block the activity of FACTOR XA.
Concepts Pharmacologic Substance (T121)
MSH D065427
LNC LP175668-5
English Factor Xa inhibitors, Inhibitors, Factor Xa, Factor Xa Inhibitors
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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