Factor Xa Inhibitor

Aka: Factor Xa Inhibitor, FXa Inhibitor

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. Oral Anticoagulant for Atrial Fibrillation as a second line alternative to Warfarin or Dabigatran (Pradaxa)
   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 including 10 fewer bleeding complications and 4 fewer deaths per 1000 patients per year
      3. References
         1. Mohammed (2012) J Cardiovasc Med 13(2):73-85
   3. Fondaparinux (Arixtra)
   4. Betrixaban
   5. Edoxaban
   6. Otamixaban
5. Management: Reversal
   1. Stop FXa Inhibitor
   2. Consider Activated Charcoal if presenting within 2 hours of suspected overdose ingestion
   3. Consider Recombinant activated Clotting Factor VII (rFVIIa) 30-90 mcg/kg (expert opinion)
   4. Dialysis is not effective (protein bound)