Factor Xa Inhibitor

Factor Xa (pronounced ten-A) inhibitors are drugs that keep your blood from clotting too much. Sometimes, people call them “blood thinners.” Healthcare providers call these medicines direct oral anticoagulants (DOACs). You can take them when you need to treat a blood clot and also as a long-term medicine to prevent blood clots.

More than 5 million Americans on Medicare take factor Xa inhibitors, according to 2023 numbers from the Centers for Medicare & Medicaid Services.

Factor Xa inhibitors have become a popular choice for people who need to take an anticoagulant. Unlike some other medicines, factor Xa inhibitors don’t require frequent blood tests.

Common brand names for factor Xa inhibitors include:

• Arixtra® fondaparinux injection
• Eliquis® (apixaban)
• Savaysa® (edoxaban)
• Xarelto® (rivaroxaban)

How do factor Xa inhibitors work?

Factor Xa inhibitors get in the way of a protein your body needs to make blood clots. Making a clot takes various steps. By keeping factor Xa from doing its part in the process, it’s like taking someone out of the assembly line. You slow down the clotting.

Factor Xa inhibitors can:

• Lower your risk of a stroke
• Lower your risk of venous thrombosis (blood clots in your veins)
• Lower the risk of cardiovascular (heart and blood vessel) events in people with coronary artery disease and peripheral artery disease
• Treat deep vein thrombosis (DVT)
• Treat pulmonary embolism (PE)
• Treat venous thromboembolism (VTE)

Some people may take factor Xa inhibitor medications because they already have a blood clot. Others may take them because they’re at risk of a blood clot. This group includes people who:

• Just received a total hip or knee replacement
• Have had a blood clot in the past
• Have atrial flutter or atrial fibrillation that doesn’t involve their heart valves
• Have poor heart function and have had a stroke in the past

What dosage strengths and forms do factor Xa inhibitors come in?

Factor Xa inhibitors come in various doses in milligrams:

• Apixaban: .5 mg, 2.5 mg, 5 mg tablets or .15 mg capsule
• Edoxaban: 15 mg, 30 mg or 60 mg tablets
• Fondaparinux: Syringes with 2.5 mg, 5 mg, 7.5 or 10 mg (for injection)
• Rivaroxaban: 2.5 mg, 5 mg, 10 mg, 15 mg or 20 mg tablets

Take the medicine as your healthcare provider instructs. Most people take the tablets once or twice a day. Don’t change your dose or stop taking your medicine until you speak with your provider.

How long will I need this medication?

The length of time you take factor Xa inhibitor medications depends on the reason you take them. Reasons for taking them and the length of time include:

• Atrial fibrillation: Possibly lifelong
• Deep vein thrombosis (DVT): At least three to six months (possibly longer)
• Pulmonary embolism (PE): At least three to six months (possibly longer)
• Venous thromboembolism (VTE): Three to six months
• Hip replacement: 35 days after surgery
• Knee replacement: 12 days after surgery

What are the potential benefits of factor Xa inhibitors?

Factor Xa inhibitor medications provide these benefits:

• Work as well or better than older drugs that prevent dangerous blood clots, depending on the reason for their use
• Have a similar or reduced risk of bleeding as other drugs, but without the need for frequent blood tests
• Start to work in a few hours
• Have fewer interactions with food and other medicines
• Provide predictable results with a set dose

What are the side effects of this drug?

Some people may have an allergic reaction (rash, chest pain, trouble breathing or dizziness). This requires medical care right away. You may also get minor bruises. But the most common side effect is bleeding, which can be life-threatening or (more commonly) minor.

Seek medical care if you have signs of bleeding or worsening illness, like:

• Bleeding that won’t stop after applying pressure for 10 minutes
• Feeling weaker or more tired than usual
• Coughing or vomiting blood (which may look like coffee grounds)
• Bleeding from your nose, gums or ears
• Having dark brown pee (urine) or red or black, tarry poop (stools)

What should I tell my healthcare provider before starting this drug?

Let your provider know which medicines, vitamins and herbal supplements you take. Tell your provider if you:

• Have kidney or liver problems
• Have had bleeding problems in the past
• Are pregnant or plan to become pregnant
• Are breastfeeding or plan to breastfeed
• Have a mechanical heart valve

What other medications and products can interact with a factor Xa inhibitor?

Your healthcare provider will review the medicines you’re taking to be sure it’s safe for you to take this drug. Certain medicines interact with factor Xa inhibitors. These include (some in combination):

• Rifampin (antibiotic)
• P-glycoprotein inhibitors or inducers
• CYP3A4 inducers or inhibitors

Other medicines may increase your risk of bleeding. These include:

• NSAIDs like ibuprofen or naproxen
• Diuretics
• ACE inhibitors (like lisinopril)
• ARBs (like losartan or valsartan)
• Immunosuppressants

Can I drink alcohol with this drug?

It’s best to avoid alcohol while taking an anticoagulant.

What’s known about factor Xa inhibitors and overdose?

Healthcare providers may use oral activated charcoal if your bleeding is uncontrollable or life-threatening. There are also other options, like giving clotting factors through an IV to manage bleeding.

What should I do if I miss a dose of a factor Xa inhibitor?

Take it as soon as you remember, unless it’s closer to the time of your next scheduled dose. Talk to your pharmacist or healthcare provider to find out what to do next. They can guide you on how to safely make up for the missed dose.

Don’t take a double dose of an anticoagulant the next day to make up for the missed dose.

Is there anything I can do to make taking factor Xa inhibitors easier on me?

Because a factor Xa inhibitor can make you bleed more than you normally would, try to avoid getting hurt. Try these tips:

• Brush and floss gently to prevent bleeding from your gums.
• Wear gloves and shoes to protect yourself when you’re doing yard work.
• Take care with scissors and knives.
• Wear gloves when washing dishes, especially knives.
• Use an electric razor instead of one that has a blade.
• Remove tripping hazards (like loose rugs) from your home to reduce your risk of falling and getting hurt.
• Avoid sports or activities that could injure you.