What Is Bevyxxa (betrixaban)?

Why Bevyxxa Is Prescribed

Blood Tests Help Monitor the Effectiveness of Blood Thinners
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Bevyxxa, also known as betrixaban, is a blood thinner approved by the Food and Drug Administration for use in hospitalized medical patients. Technically speaking, this medication is a Factor Xa inhibitor, meaning that Bevyxxa delays the blood clotting process to prevent clotting.

It is essential to life that blood forms clots, otherwise we would bleed to death after a papercut that never quit bleeding, or from a bloody nose. If the blood didn’t clot we would not survive the smallest of injuries, but blood that clots too well can also cause serious problems.

For hospitalized patients, the risk of blood clots is often much higher than the risk of bleeding too much.  For that reason, medication is given to “thin” the blood and make the blood take longer to clot. This can prevent the formation of clots in the body.

What Bevyxxa Does

Blood thinners are used to make the blood take longer to form clots, which can reduce the risk of some serious and life-threatening complications caused by blood clots. While many people take blood thinners on a daily basis due to a heart condition that is known to cause clots, Bevyxxa is use to prevent a different type of clot that commonly forms during hospital stays for illness.

These blood clots often form in the extremities—most often the legs—a condition known as deep vein thrombosis (DVT). In some cases, a clot that has formed in the leg or arm will break free and start to travel through the bloodstream, lodging in the lung where it becomes a life-threatening condition called a pulmonary emobolism, or PE.

For hospitalized patients who are not expected to have surgery, Bevyxxa is indicated for the prevention of blood clots both in the hospital and after discharge. Prior to the approval of Bevyxxa, there were two medications used for the same purpose, Heparin and Lovenox (enoxaparin). Both of these medications are used in the hospital, but are given as injections so the patients must be transitioned to a different medication for use at home.

Unlike Heparin and Lovenox, Bevyxxa can be used in the hospital and after discharge to prevent clots, as the medication is taken as a pill, rather than as an injection.

Why Bevyxxa Is Used

Bevyxxa has been approved by the FDA to be released to the public and will appear in hospitals and pharmacies for use in individuals who are at risk of forming a blood clot. Hospitalized patients have a known increased risk of forming a blood clot, and the sicker the patient is, typically, the higher the risk.  For that reason, medication is often given to prevent the formation of blood clots.

How Bevyxxa Is Different

In studies, Bevyxxa was slightly more effective than Lovenox (enoxaparin) injections. The real difference between Bevyxxa and the medications currently being used are the frequency of dosing and the route of administration.

Heparin is typically administered two or three times per day and is an injection. Lovenox is also an injection and is given once a day. Additionally, injections are not typically able to be continued at home and the patient must be transitioned to a different medication—a process that can lead to longer hospitalizations in some cases—so the real benefit to Bevyxxa is that the patient can take it both in the hospital and at home.

Pricing on this medication was not yet announced as of July 2017, so it is unclear if the price is competitive with competing inpatient drugs Heparin and Lovenox. It is unlikely that this new medication will be less expensive than Coumadin (warfarin), which is available in generic.

It is expected that Bevyxxa will be price competitive with other newer blood thinning medications that are taken in pill form outside the hospital setting, such as Eliquis, Pradaxa and Xarelto.

How Bevyxxa Is Taken

Bevyxxa is taken by mouth in pill form, preferably with food, once a day. It is best to take this medication at the same time daily for best results. 

Risks of Bevyxxa

Like all blood thinners, Bevyxxa is going to increase the chances of having bleeding. This may mean that a normal wound, such as a papercut, will bleed more and longer than it would have before taking this medication.  A small cut while shaving may result in more blood than is typical, and the same is true of menstrual bleeding or an injury. This is a known risk of taking all blood thinners and is not specific to Bevyxxa.

Bevyxxa does not have a reversal agent, meaning there is no known medication that makes the effects of Bevyxxa stop immediately in the event of bleeding. This can make it difficult to stop bleeding if there is a traumatic injury, internal bleeding or other types of bleeding issues. If bleeding is severe or life-threatening, transfusion to replace blood loss will be the most effective treatment.

Bruising can also be much more significant when taking Bevyxxa or any type of blood thinning medication. Other reactions not related to bleeding during the drug trials for this medication included:

When to Call Your Doctor

While more bleeding is normal with blood thinners, it is not normal to have blood in your stool, a condition called melena. It is also not normal to see blood in your urine, another indication that bleeding is taking place that should not be. Along with those symptoms, below are other examples of when to see a doctor regarding use of a blood thinner:

  • Severe headache
  • Dizziness or unexplained weakness
  • Unexplained pain, including joint pain
  • Frequent nosebleeds
  • Bleeding gums

If you take too much Bevyxxa, call your doctor or go to the nearest emergency room.

If you experience dark or tarry stools, vomit and see what looks like coffee grounds, or have blood in your urine (pink, red, or brown urine), you should call your healthcare provider immediately.

Any head injury, such as a fall that results in striking the head, should also be reported. It is much easier to have an episode of bleeding on the brain when taking this type of medication, and the faster treatment is started the better the final outcome.

Who Should Not Take Bevyxxa

  • Like all blood thinning medications, Bevyxxa should not be taken by anyone with active bleeding.
  • This medication has not been studied for use in pediatric patients.
  • Bevyxxa has not been studied for use in pregnant women or breastfeeding women. Use in women who are pregnant or nursing should only be considered when the benefits of thinning the blood are greater than the risks of doing so. Since Bevyxxa has not been studied in breast feeding women, it is safer to avoid exposing the infant to the medication and use supplemental milk instead.
  • Patients who have difficulty with blood clotting should not take this medication.
  • Patients with kidney disease may require a decreased daily dose.
  • Individuals with known liver disease should not use this medication. Liver disease can decrease the body's ability to clot and can lead to serious complications when taking this medication.
  • Patients with artificial heart valves have not been studied, so it is not known whether this medication is effective for those people.
  • Patients who are on Bevyxxa and will have spinal or epidural anesthesia are at higher risk for hematoma, a large collection of blood at the puncture site. While this might not sound like a significant issue, in severe cases this can lead to nerve damage or even paralysis.
  • Women who are of child bearing age should use this medication with caution as menstrual bleeding could be significant with this medication. Women with heavy bleeding could experience anemia or even hemorrhage with this medication or any blood thinner. If you are planning to become pregnant, discuss your wishes with your doctor.
  • Patients who are taking other medications that are known to increase the risk of bleeding, such as aspirin, some depression medications, ibuprofen and naproxen, and other blood thinners are at increased risk for severe bleeding problems.

Dosing of Bevyxxa

The typical dosing of Bevyxxa is a first dose of 160 milligrams (mg) followed by a daily dose of 80 mg.  Doses should be reduced for patients who have severe kidney disease. This medication has been studied for use for 5 to 7 weeks, longer duration of use is possible, but information is not yet available.

Bevyxxa is available in an 40mg or 80 mg dose strength. Patients taking the following common medications, which are P-glycoprotein inhibitors, will require lower doses of Bevyxxa:

  • Amiodarone (Cordarone)
  • Azythromycin
  • Clarithromycin
  • Cyclosporine
  • Colchicine
  • Diltiazem
  • Erythromycin
  • Felodipine
  • Ketoconazole
  • Lansoprazole (Prevacid)
  • Omeprazole (Prilosec)
  • Nifedipine (Procardia)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Quinidine
  • Tamoxifen
  • Verapamil

If You Miss a Dose of Bevyxxa

If you miss a dose of this medication, and your next dose is eight or more hours away, take the missed dose. Otherwise, you should skip the dose and take your next dose as scheduled.

A Word From Verywell

Bevyxxa is a brand new medication approved by the FDA in June of 2017 for use in non-surgical hospitalized patients during their hospitalization and during their recovery. At this time of this writing, Bevyxxa is not yet available to the general public. While the initial results from the studies done on this medication are promising, more information about long term use, side effects, risks and benefits will become available as more patients use the medication.

At this time, research indicates that this medication does prevent clots in patients during their hospital stay and in the weeks of recovery that follow, and it is as effective or more effective than other similar medications.

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