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re notsensitive for particular, single-target anticoagulants such asthe FXa inhibitors. As shown in Fig. 5, apixaban onlyprolonged ex vivo aPTT and PT modestly, even at thehighest dose that made 80% antithrombotic efficacy inrabbits. As expected from its mechanism of action,apixaban Cell Signaling inhibitor did not prolong thrombin Cell Signaling inhibitor time. Among theclotting time tests, mPT was one of the most sensitive for apixabanand tracked nicely with the antithrombotic activity ofapixaban. Equivalent mPT final results had been also observed with.other FXa inhibitors for instance rivaroxaban. Data from aphase II study with apixaban show that the anti-FXa assayis a lot more correct and precise than the mPT test.Indeed, we also observed that the anti-FXa assay trackedwell with antithrombotic activity in rabbits with arterialthrombosis. As shown in Fig.
6, apixaban made adose-dependent inhibition of FXa and did not inhibitthrombin activity ex vivo. The ex vivo fgf inhibitor anti-FXaactivity of apixaban correlated nicely with both its antithromboticactivity and plasma concentration.Hence, the anti-FXa activity assay may well be suitable formonitoring the anticoagulant and plasma levels of apixabanif needed in particular scenarios for instance an overdose, acutebleeding or urgent surgery.Drug metabolism and pharmacokineticsThe metabolism and pharmacokinetics of apixaban havebeen studied extensively in animals and humans. In thesestudies, absorption of apixaban following oral administrationwas rapid, with a time to peak plasma concentrationof 1–2 h. Absolute oral bioavailability of apixaban wasgood in rats, dogs and humans.
Following IVadministration, apixaban was slowly eliminated in rats,dogs and humans, with an apparent terminal eliminationhalf-lifeof 2–11 h, along with a total plasma clearance ofless than 5% hepatic blood flow. The steady-state volumeof distribution for apixaban was low in rats, dogs andhumans. Such steadystatevolume of distribution values are indicative of a largeportion HSP from the drug remaining within the target compartment. Apixaban had a greater clearance along with a lowerbioavailability in rabbits compared with rats, dogs, chimpanzeesor humans. In humans, apixaban features a lowpeak-to-trough ratio of around 4 or much less followingoral administration. Serum protein binding did notappear to be concentration dependent within the range of 0.5–5.Table 4 summarizes the pharmacokinetic properties ofapixaban in animal species and humans.
In animals and humans receivingapixaban, theparent compound was the predominant component inplasma and excreta, althoughnumerous metabolites had been detected at reasonably lowconcentrations. fgf inhibitor Metabolic pathways of apixabanin animals and humans are presented in Figs. 7 and 8.In humans, O-demethyl apixaban, O-demethylapixaban sulfate, 3-hydroxy apixabanandhydroxylated O-demethyl apixabanwere the mostabundant in vivo metabolites. Of these, O-demethyl apixabansulfate was the predominant circulating humanmetabolite, with levels of exposure to this metaboliteequivalent to around 25% of those of apixaban;exposure to other metabolites did not exceed 5% of parent. General, around 25% from the dose was recoveredas metabolites in humans, primarily within the feces.
O-Demethylapixaban followed by O-demethyl apixaban Cell Signaling inhibitor sulfate,3-hydroxy apixaban and hydroxylated O-demethyl apixaban,had been one of the most abundant metabolites in human excreta.These metabolites had been also formed in animal speciesduring non-clinical safety assessments. Right after administrationofapixaban in mice, rats and dogs, no metaboliteexceeded 5% from the total plasma radioactivity at any timepoint. Even though O-demethylapixaban sulfate could be the big human circulating metabolite,it does not have meaningful pharmacological activity. In thein vitro enzyme assay, this metabolite did not significantlyinhibit purified human FXa at concentrations below 20 lM,and did not inhibit thrombin or trypsin at concentrations upto 30 lM. In addition, O-demethyl apixaban sulfate doesnot possess structural alerts and is of no toxicologicalconcern.
Primary biotransformation reactions of apixaban includeO-demethylation and mono-oxidation; fgf inhibitor in some species,opening from the keto-lactam ring and hydrolysis from the amidemoiety are additional minor pathways. Combinationsof these reactions had been also observed as sulfation ofO-demethyl apixaban, sulfation of hydroxylated O-demethylapixaban and glucuronidation of O-demethyl apixaban. Apixaban was metabolized quite slowly inliver microsomes and hepatocytes, even though O-demethylapixaban was formed in hepatocytes from all species, whileO-demethyl apixaban sulfate was detected in rat, monkeyand human hepatocytes only. No metabolites had been formedby human kidney microsomes or human intestinal S9fraction. Similarly, no glutathione adduct of apixaban wasdetected in microsomes or hepatocytes, indicating that theformation of reactive metabolites with apixaban is unlikely.The in vitro metabolism of apixaban was primarily mediatedby CYP3A4/5, with reasonably minor contributionsfrom CYP1A2 and CYP2J2 towards the formation ofO-demethyl apixaban. In ad