Inflammation and Atherothrombosis: The Beginning of the End of a Hypothesis

<p>Abstract: The inflammatory hypothesis for atherothrombosis posits that inflammation drives the development of atherosclerotic plaque and its progression to thrombosis. Empirical data have suggested the relation of inflammation to the Virchow’s triad: endothelial injury, blood stasis, and hypercoagulable state. Evidence from clinical studies also pointed to a potential benefit in thrombotic risk reduction from inhibiting inflammation. Until recently, interleukin-1β blockade with canakinumab has been investigated for preventing recurrent cardiovascular events among patients with prior myocardial infarction and demonstrated compelling outcomes. Furthermore, the results ascertain that a downstream inflammatory biomarker, high-sensitivity C-reactive protein, could be utilized to identify at-risk patient subsets associated with significant benefits from anti-inflammatory therapy. As research efforts are closing the knowledge gap between inflammation and thrombosis, the potential role of inflammation in other cardiovascular diseases also presents new challenges for future studies.</p

Betrixaban for first-line venous thromboembolism prevention in acute medically ill patients with risk factors for venous thromboembolism.

Compared to other direct oral anticoagulants, betrixaban has a longer half-life, smaller peak-trough variance, minimal renal clearance, and minimal hepatic Cytochrome P (CYP) metabolism. The Acute Medically Ill VTE Prevention with Extended Duration Betrixaban (APEX) trial evaluated the efficacy and safety of extended duration betrixaban compared to standard duration enoxaparin in acutely ill hospitalized patients. Areas covered: This article describes the role of betrixaban in the prevention of venous thromboembolism (VTE) in acutely ill medical patients. This article provides a consolidated summary of the primary APEX study findings as well as prespecified and exploratory substudies. This article also provides a review of the results of studies in which other direct factor Xa inhibitors have been evaluated in an extended duration regimen in this patient population. Expert commentary: While previous agents have demonstrated that extended duration VTE prophylaxis can be efficacious, betrixaban is the first agent to demonstrate efficacy without an increase in major bleeding. The totality of the data from the APEX trial supports extended duration betrixaban for VTE prophylaxis in the acute medically ill patient population. As such, betrixaban has been approved in the USA for extended VTE prophylaxis in at-risk acute medically ill patients