The Expanded Role of Apixaban in Cardiovascular Disease Management: A Literature Review

Abstract

Direct Oral Anticoagulants (DOACs) are widely used for stroke prevention in non-valvular atrial fibrillation, treatment of deep venous thrombosis and pulmonary embolism, and prophylaxis of Venous Thromboembolism (VTE) after hip and knee surgery. Apixaban, a Factor Xa inhibitor, is one of the most efficacious DOACs with some of the lowest bleeding rates. It has therefore been widely adopted into clinical practice. In the recent years, its usefulness has been tested outside traditional clinical paradigms in coronary artery disease, VTE in malignancy, and deep venous thrombosis prophylaxis in acute medical illnesses. Other off label uses include treatment of left ventricular thrombus and transient post procedural use in transcatheter aortic valve replacement and left atrial appendage occlusion device placement. This review systematically evaluates the clinical evidence and knowledge gaps in expanded clinical use of apixaban.