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New Anti-Clotting Drug May Work Better After Hip Replacement
Date:12/23/2010

p replacement, patients typically receive (warfarin) Coumadin, a blood thinner that inhibits clotting. But Coumadin takes a day or more to kick in, so patients usually are immediately put on enoxaparin, Stein added.

There are several drawbacks to that strategy. Enoxaparin is delivered by injection, whereas apixaban can be taken in oral form.

Coumadin can be somewhat unpredictable and patients taking it have to be monitored, Stein said.

"It often is difficult to find the right dosage. Sometimes we overshoot and patients are at risk of bleeding, and sometimes we undershoot and they are at risk of getting the clot in their vein," Stein said.

The new drug seemed to reduce clots by nearly half and resulted in slightly fewer problems with bleeding at the surgical site, Stein said.

"This is an important article," Stein said. "They showed a reduction in bleeding and a reduction in major and minor complications, including deep vein thrombosis, non-fatal pulmonary embolism or cardiac death, which usually means fatal pulmonary embolism. They showed those risks were reduced substantially in the group taking the apixaban compared to the enoxaparin group."

Apixaban is also being studied for use after knee replacement surgery and for patients with atrial fibrillation, among other conditions. In addition to the hip replacement study, there are eight other completed or ongoing Phase III clinical trials involving the drug, Trank said.

Apixaban is one of several drugs under development that work by inhibiting factor Xa in the blood, according to an accompanying editorial that predicts a huge impact if the drug is "conscientiously priced."

Bristol-Myers Squibb declined to provide information about the cost of the drug.

More information

The U.S. National Heart, Lung, and Blood Institute has more on deep vein thrombosi
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