Apixaban decreases coagulation activity in patients with acute deep-vein thrombosis

Thromb Haemost. 2011 Jan;105(1):181-9. doi: 10.1160/TH10-06-0393. Epub 2010 Oct 12.


In patients with acute deep-vein thrombosis (DVT), apixaban, a direct oral factor Xa inhibitor, showed efficacy and safety similar to low-molecular-weight heparin followed by vitamin K antagonist (LMWH/VKA). We evaluated biomarkers of coagulation activity in relation to treatment dose, duration and clinical outcome. Patients (N = 520) with symptomatic DVT were randomised to receive apixaban (5 mg bid, 10 mg bid or 20 mg qd) or LMWH/VKA for 12 weeks. Plasma D-dimer, prothrombin fragment 1+2 (F1+2) and thrombin-antithrombin complex (TAT) levels were measured at baseline, and weeks 3 and 12 after treatment. Median plasma levels of D-dimer, F1+2 and TAT were elevated at baseline. At weeks 3 and 12, biomarker levels were normalised in most patients in all treatment groups, consistent with the low rate of venous thromboembolism (VTE) observed. Median reduction in D-dimer was similar in all treatment groups; percentage of patients with D-dimer above upper limit of normal decreased from 95% to 24-40% at week 12. F1+2 decline was greater with LMWH/VKA than apixaban. F1+2 in the apixaban groups changed to a similar extent (>84% of patients had F1+2 within reference range at week 12). Magnitude of TAT reduction was not quantifiable. In conclusion, levels of coagulation biomarkers decreased over 12 weeks of treatment with apixaban or LMWH/VKA in most patients with acute VTE. Baseline D-dimer and F1+2 were higher in patients with recurrent symptomatic VTE than in those without. Plasma levels of coagulation biomarkers did not appear to correlate with total bleeding events.

Publication types

  • Clinical Trial, Phase II
  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anticoagulants / therapeutic use
  • Biomarkers / blood
  • Blood Coagulation / drug effects*
  • Dose-Response Relationship, Drug
  • Hemorrhage / chemically induced
  • Heparin, Low-Molecular-Weight / administration & dosage
  • Heparin, Low-Molecular-Weight / pharmacology
  • Humans
  • Pyrazoles / administration & dosage
  • Pyrazoles / pharmacology*
  • Pyrazoles / therapeutic use
  • Pyridones / administration & dosage
  • Pyridones / pharmacology*
  • Pyridones / therapeutic use
  • Treatment Outcome
  • Venous Thrombosis / complications
  • Venous Thrombosis / drug therapy*


  • Anticoagulants
  • Biomarkers
  • Heparin, Low-Molecular-Weight
  • Pyrazoles
  • Pyridones
  • apixaban