Pharmacology · patient case question
What is the mechanism of action of apixaban?
Patient case: Polypharmacy — Cardiovascular & GI
demo: 68-year-old male
chief: “I need a crown on my lower left molar.”
history: Hypertension, gastroesophageal reflux disease, atrial fibrillation, hyperlipidemia, gout. Non-smoker.
meds: Lisinopril, omeprazole, verapamil, apixaban, rosuvastatin, allopurinol
findings: BP 132/84 mmHg. Generalized attrition. Tooth #19 with fractured MOD amalgam, no pulpal symptoms. No active periodontal disease.
Show answer and explanation
Correct answer: D. Direct inhibition of factor Xa
- A. Direct thrombin inhibition is dabigatran.
- B. Potentiating antithrombin III by bringing it together with thrombin is heparin.
- C. Blocking vitamin K recycling — and therefore factors II, VII, IX, and X — is warfarin.
- D. Correct. Apixaban and rivaroxaban selectively bind the active site of factor Xa, preventing conversion of prothrombin to thrombin.