apixaban / Generic mfg. - LARVOL DELTA

JARISCH-HERXHEIMER REACTION AND NEW-ONSET ATRIAL FIBRILLATION IN A PATIENT WITH TICK-BORNE RELAPSING FEVER FOLLOWING CAMPING EXPOSURE IN FRAZIER PARK, CALIFORNIA (WRMC 2026) - "She was started on doxycycline and developed acute wheezing, rigors, and tachypnea, clinical features consistent with a systemic JHR, necessitating treatment with systemic corticosteroids and epinephrine. During hospitalization, she developed new-onset atrial fibrillation, requiring anticoagulation with apixaban...This case underscores several important considerations in the diagnosis and management of TBRF: (1) the challenge of interpreting serologic and molecular testing due to cross-reactivity among Borrelia species; (2) the need to anticipate and manage JHR, particularly in patients with underlying inflammatory conditions; and (3) the potential for cardiac complications such as atrial fibrillation, especially in older adults. Clinicians should maintain a high index of suspicion for TBRF in patients with relevant tick exposure and recognize that early antimicrobial treatment may precipitate severe systemic reactions requiring prompt supportive care."

Clinical • Atrial Fibrillation • Cardiovascular • Celiac Disease • Hypertension • Immunology • Infectious Disease • Inflammation • Inflammatory Arthritis • Lyme Disease • Musculoskeletal Pain • Rheumatoid Arthritis • Rheumatology • Systemic Inflammatory Response Syndrome

Thrombotic and Hemorrhagic Adverse Events of Direct Oral Anticoagulants: An Analysis of Sex-Related Differences Using Food and Drug Administration Adverse Event Reporting System. (PubMed, Anatol J Cardiol) - "Significant sex-specific differences exist in DOAC safety profiles. Recognizing these patterns may inform individualized anticoagulant selection and enhance pharmacovigilance-driven personalized medicine."

Adverse events • Journal • Cardiovascular • Cerebral Hemorrhage • CNS Disorders • Hematological Disorders • Ischemic stroke • Myocardial Infarction • Pulmonary Embolism • Respiratory Diseases

Plasminogen Activator Inhibitor-1 Gene Polymorphism in Recurrent Ischemic Stroke Despite Anticoagulation: An Observational Study (ISC 2026) - "Fifteen patients (75%) were on Apixaban and 5 (25%) were on Rivaroxaban...This included 7 switching from a factor Xa inhibitor (FXa-I) to a direct thrombin inhibitor (DTI), 3 changing to a different FXa-I, 2 adding aspirin, 2 transitioning from FXa-I to warfarin, and 1 switching from FXa-I to DTI with aspirin...Limitations include the small sample size and variable duration of follow-up, which may have prevented detection of recurrent events in patients with other genotypes. Larger, prospective studies are warranted to further clarify this association and guide more effective therapeutic strategies."

Clinical • Observational data • Cardiovascular • Hematological Disorders • Ischemic stroke

DOAC Pharmacologic Interactions in Acute Ischemic/TIA vs Hemorrhagic Stroke: Findings from a 77-Hospital Telestroke Program (ISC 2026) - "DOAC distribution: rivaroxaban 314/446 (70.4%) , apixaban 101/446 (22.6%) , edoxaban 17/446 (3.8%) , dabigatran 14/446 (3.1%) . Cerebrovascular presentations: ischemic stroke 381/446 (85.4%) , non-SAH hemorrhagic stroke 41/446 (9.2%) , SAH 18/446 (4.0%) , TIA 6/446 (1.3%) .Interaction prevalence by event group (pre-specified comparison of ischemic/TIA vs hemorrhagic:Ischemic/TIA (n=387): – PD (bleeding-risk): 130/387 (33.6%) – PK inhibitors (↑ exposure): 37/387 (9.6%) – PK inducers (↓ exposure): 18/387 (4.7%) Hemorrhagic (n=59): – PD (bleeding-risk): 15/59 (25.4%) – PK inhibitors (↑ exposure): 7/59 (11.9%) – PK inducers (↓ exposure): 6/59 (10.2%) PD combinations consistently exceeded PK DDIs overall, driven primarily by acetylsalicylic acid/aspirin and clopidogrel; heparins were less frequent. Among PK interactions, amiodarone predominated as an inhibitor and phenytoin as an inducer. The relative excess of PD DDIs in ischemic/TIA and the higher proportions of PK..."

Clinical • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

The Risk of Recurrent Ischemic Stroke in patients on DOAC: A Retrospective analysis (ISC 2026) - "The physicians' top 5 preferences after the first time stroke were to continue with Apixaban (21.7%), switch Apixaban to Rivaroxaban (19.4%), switch Rivaroxaban to Apixaban (15.5%), switch Apixaban to Warfarin (10.1%), and continue with Rivaroxaban (7.0%). In our analysis, continuing the same DOAC was associated with a higher—but not statistically significant—risk of recurrence compared to switching. Larger, prospective studies are needed to determine whether switching DOACs offers a protective benefit."

Retrospective data • Cardiovascular • Ischemic stroke

Risk Factors for Ischemic Events in Patients with Embolic Stroke of Undetermined Source: A Post-Hoc Analysis of the ARCADIA Trial (ISC 2026) - "In this post-hoc analysis of the ARCADIA trial, history of diabetes, prior stroke or TIA, and reduced ejection fraction were associated with increased recurrence risk, but only those with reduced ejection fraction seemed to benefit from anticoagulation."

Clinical • Retrospective data • Atrial Fibrillation • Cardiovascular • Diabetes • Ischemic stroke • Metabolic Disorders

Contemporary U.S. Practice Patterns Regarding Anticoagulation and LAA Closure in ICH Survivors with Atrial Fibrillation (ISC 2026) - "We used RxNorm codes to identify prescriptions for aspirin and anticoagulant drugs, specifically warfarin, apixaban, dabigatran, or rivaroxaban. In this large, contemporary national U.S. cohort of patients with AF and ICH, approximately half were started on anticoagulation after discharge, and the remainder were mostly treated with aspirin only. Fewer than 1 in 20 patients underwent LAA occlusion, even in recent years. These findings suggest ongoing uncertainty and equipoise between anticoagulant and antiplatelet therapy for secondary stroke prevention in patients with AF and ICH."

Atrial Fibrillation • Cardiovascular • Cerebral Hemorrhage • Hematological Disorders • Ischemic stroke

Variable Rate of Anticoagulation Response to Direct Oral Anticoagulants (DOACs) in Acute Ischemic Stroke: The Potential of Point-of-Care DOAC Anticoagulation Measurement (ISC 2026) - "We found significant differences in CKCT between the groups, with highest mean CKCT in the No Stroke w/ DOAC group, followed by Normal (reference), Stroke w/ DOAC, and Stroke No DOAC (p<0.01) (Figure 1 ). In No Stroke w/ DOAC, CKCT and anti-factor Xa levels were highly correlated: R2 values, 0.99 / 0.98 for rivaroxaban / apixaban, respectively. In Stroke w/ DOAC, anti-Xa levels were therapeutic but CKCT was below normal, with no meaningful correlation between anti-Xa and CKCT: R2 <0.02.Conclusion : For the first time, we report data showing marked differences in DOAC effect between pts with and without AIS."

Late-breaking abstract • Cardiovascular • Ischemic stroke • Thrombosis

Clinical outcomes of DOACs versus warfarin for ischemic stroke caused by left ventricular thrombus: a retrospective single-center study (ISC 2026) - "Five patients were switched from warfarin to a DOAC over the 6-month period.There was no statistically significant difference in thrombus resolution rates between warfarin, apixaban, and rivaroxaban use at initial diagnosis (p = 0.6) (Table 3). Warfarin may be associated with greater complication risk within this time period and more difficulties for patient adherence. These factors should be taken into consideration when selecting an anticoagulant agent for patients diagnosed with LVT."

Clinical data • Retrospective data • Cardiovascular • Ischemic stroke • Thrombosis

Potential Benefit of Apixaban Among Patients Without High-Risk Hypertension In Cryptogenic Stroke: A Secondary Analysis of the ARCADIA Trial (ISC 2026) - "We sought to determine whether systemic evidence of high-risk hypertension (HRH) modifies the treatment effect of anticoagulation versus antiplatelet therapy after cryptogenic stroke. This secondary analysis of the Apixaban to Prevent Recurrence After Cryptogenic Stroke in Patients With Atrial Cardiopathy (ARCADIA) trial assessed whether HRH modified the effect of apixaban versus aspirin in patients with cryptogenic stroke and atrial cardiopathy. Evidence of HRH modified the effect of anticoagulation treatment in patients with cryptogenic stroke and atrial cardiopathy. An underappreciated inclusion of strokes due to hypertensive arteriopathy may account for the absent benefit of anticoagulation in prior trials of embolic stroke of unknown source."

Clinical • Cardiovascular • Hypertension • Ischemic stroke

VALIANT-AF-T: Comparing the Safety and Efficacy of Apixaban and Rivaroxaban (clinicaltrials.gov) - P4 | N=10000 | Not yet recruiting | Sponsor: VA Office of Research and Development | Initiation date: Jun 2025 ➔ Mar 2026

Trial initiation date • Atrial Fibrillation • Cardiovascular

Embedding Randomisation in a National Ckd Registry: For the Sack Study of Apixaban in Atrial Fibrillation (ISN-WCN 2026) - No abstract available

Atrial Fibrillation • Cardiovascular

Atypical soft palate pyogenic granuloma in an elderly anticoagulated patient presenting with acute oropharyngeal hemorrhage. (PubMed, J Surg Case Rep) - "We report a 69-year-old female on Apixaban who presented with sudden, profuse oropharyngeal bleeding...No recurrence was observed at follow-up. This case highlights the importance of prompt recognition and complete excision of PG in anticoagulated patients, as even small lesions may precipitate life threating hemorrhage."

Journal • Anesthesia • Hematological Disorders

Prevalence of abnormal uterine bleeding and quality of life after venous thromboembolism by oral anticoagulant use: the GENB-OAC Study. (PubMed, Res Pract Thromb Haemost) - "Apixaban is associated with less AUB than rivaroxaban or VKAs with no difference in QoL. An international consensus is necessary to help clinicians detect and treat AUB in OAC users."

HEOR • Journal • Cardiovascular • Hematological Disorders • Venous Thromboembolism • Women's Health

Encequidar is a multispecies gut-restricted P-glycoprotein inhibitor that delineates between intestinal secretion and biliary elimination in animals and predicts human disposition pathways. (PubMed, Drug Metab Dispos) - "We show that encequidar can inhibit intestinal secretion of known P-glycoprotein substrates (paclitaxel, apixaban, and talinolol) in rat and dog. SIGNIFICANCE STATEMENT: Encequidar is a potent, gut-restricted P-glycoprotein (P-gp) inhibitor that boosts oral bioavailability of P-gp substrates in the commonly used nonclinical species of rat, dog, and monkey. Encequidar is a suitable in vivo P-gp inhibitor to determine the main routes of elimination and differentiate between intestinal secretion and biliary elimination of P-gp substrates using intact animal models."

Journal • Solid Tumor

Unmasking a Culprit: A Case of Apixaban-Induced Subacute Cutaneous Lupus Erythematosus (AAD 2026) - No abstract available

Clinical • Cutaneous Lupus Erythematosus • Immunology • Inflammatory Arthritis • Lupus

Evaluating patient acceptability of clinical pharmacist engagement following clinical decision support. (PubMed, Explor Res Clin Soc Pharm) - "While Direct Oral Anticoagulant (DOAC) medications like apixaban and rivaroxaban have overtaken warfarin as first-line therapy for atrial fibrillation (AF) and venous thromboembolism (VTE), 10-20% of DOAC prescriptions deviate from the United States Food and Drug Administration (FDA) evidence-based package label instructions. Anticoagulation pharmacists' direct outreach to patients can be valuable for DOAC management and is generally well-accepted. Addressing role confusion could further facilitate their direct patient contact."

Journal • Atrial Fibrillation • Cardiovascular • Venous Thromboembolism

Deep Venous Thrombosis Within Two Weeks of Initiating Oral Semaglutide (Rybelsus): A Case Report. (PubMed, Cureus) - "Anticoagulation with low molecular weight heparin followed by apixaban resulted in significant clinical improvement. Clinicians should maintain vigilance, especially in adolescents and individuals self-prescribing for weight loss. Further pharmacovigilance and mechanistic studies are warranted to clarify this potential association."

Journal • Cardiovascular • Diabetes • Hematological Disorders • Metabolic Disorders • Obesity • Pain • Thrombosis • Type 2 Diabetes Mellitus • Venous Thromboembolism

Navigating Perioperative Anticoagulation Challenges in a Cancer Patient With Deep Vein Thrombosis: A Case Report. (PubMed, Cureus) - "To balance this, an inferior vena cava (IVC) filter was placed, and enoxaparin was initiated with a personalized perioperative regimen. The patient was stabilized and transitioned to lifelong apixaban before discharge. This case underscores the complexities of anticoagulation in oncologic orthopedic patients, highlighting the individualized approach and real-time adjustments in anticoagulation management to balance thrombotic and bleeding risks, especially in light of unforeseen clinical developments."

Journal • Bladder Cancer • Cardiovascular • Hematological Disorders • Musculoskeletal Diseases • Oncology • Solid Tumor • Thrombosis • Urothelial Cancer • Venous Thromboembolism

Effect of Apixaban on early anastomotic stenosis after arteriovenous fistula creation for hemodialysis. (PubMed, J Vasc Access) - "Apixaban might be beneficial for decreasing early AVF maturation failure in patients requiring HD."

Journal • Cardiovascular • Hematological Disorders • Thrombosis

DOAC - Dosing Options in AntiCoagulation Prophylaxis (clinicaltrials.gov) - P3 | N=996 | Recruiting | Sponsor: University of Vermont | Not yet recruiting ➔ Recruiting

Enrollment open • Cardiovascular • Oncology • Venous Thromboembolism

Idiopathic Renal Infarct in a Healthy Adult With an Accessory Renal Artery: A Case Report. (PubMed, Cureus) - "The patient was treated with anticoagulation using unfractionated heparin followed by apixaban...Early contrast-enhanced imaging is crucial for diagnosis. Prompt anticoagulation can prevent progression and preserve renal function."

Journal • Cardiovascular • Hematological Disorders • Immunology • Mood Disorders • Nephrology • Pain • Renal Calculi • Renal Disease

Direct Oral Anticoagulant Levels at Time of Elective Surgery. (PubMed, JAMA Netw Open) - "This cohort study (DOAC Level Prior to Incision [DALI]) assessed adult patients prescribed a DOAC (apixaban, dabigatran, or rivaroxaban) for any indication and at any dose, undergoing an elective procedure requiring DOAC interruption between May 27, 2018, and February 25, 2024, at 2 Dutch hospitals. In this cohort study, most patients following the current protocol had DOAC levels less than 30 ng/mL, although the proportion of patients with elevated levels was higher for apixaban. Preoperative DOAC levels were not associated with blood loss during surgery."

Journal

In Vitro Evidence of Therapy-Induced Suppression of Prothrombotic and Proinflammatory Phenotypes in Severe COVID-19. (PubMed, Thromb Haemost) - "Human microvascular endothelial cells were cultured in medium supplemented with pooled serum within the same disease stage, with or without defibrotide, apixaban, or tocilizumab. Defibrotide mitigated COVID-19 serum induced p38MAPK and Erk activation but enhanced Akt phosphorylation.Serum from severe COVID-19 patients induces a proinflammatory and prothrombotic endothelial phenotype, which can be modulated by endothelial-targeted therapies. These findings support the potential clinical value of endothelial-directed treatments."

IO biomarker • Journal • Preclinical • Infectious Disease • Novel Coronavirus Disease • Pneumonia • Respiratory Diseases • TLR4 • VCAM1

Prescribing patterns of apixaban and rivaroxaban for extended-phase anticoagulant therapy. (PubMed, Am J Health Syst Pharm) - "The majority of patients were prescribed full-dose rivaroxaban or apixaban for extended-phase anticoagulation, despite guidance suggesting use of a reduced dose. Prescribers may consider patient-specific risks for thrombosis and bleeding when selecting a dose of apixaban or rivaroxaban for VTE prevention."

Journal • Cardiovascular • Chronic Kidney Disease • Genetic Disorders • Hematological Disorders • Nephrology • Oncology • Renal Disease • Sickle Cell Disease • Venous Thromboembolism