Oral factor Xa inhibitors

Abstract Oral factor Xa (FXa) inhibitors exert their antithrombotic effects and increase the risk of bleeding by their effects on the coagulation system. The oral direct FXa inhibitors are highly potent, reversible active-site inhibitors of FXa with good bioavailability, rapid onset, and used in a daily standard dose without laboratory monitoring. Dose adjustment is needed in relation to renal function. Three FXa inhibitors are registered for clinical use in the European Union for the prevention and treatment of venous thromboembolism and for the prevention of stroke in atrial fibrillation—rivaroxaban, apixaban, and edoxaban. The FXa inhibitors provide similar or better protection against venous thromboembolism and stroke than warfarin. In patients with atrial fibrillation there is improved long-term survival as compared with warfarin. Simultaneously, there is a much lower risk of intracranial bleeding and, with apixaban and edoxaban, also a lower risk of all bleeding than with warfarin. The treatment is cost-effective and preferred by most patients.