When do you expect apixaban to be submitted for approval and how do you anticipate it fitting in?

This is a complicated case. It is an example of the typical kinds of problems practioners face when their patients are taking oral direct thrombin inhibitors: Should they be continued during relatively "minor" surgical procedures? 

A  76 y.o. male experienced a large stroke in the right mid temporal lobe. Subsequent evaluation showed DVT, PFO with right to left shunt and left septal anneurysmal dilation. The patient had been on a 600 mile auto trip 2 weeks prior to the stroke. There were no neurological sequelae. 21 years earlier the patient had had a PTCA for a symptomatic 75% LAD artery occlusion. All cardiovascular risk factors since that time were well controlled medically and the patient remained physically active, golfing 3 times a week.

Two weeks  after the stroke the patient experienced a new onset of paroxysmal atrial fibrilation, ventricular rate 130, associated with weakness and lightheadedness severe enough to be incapacitated and was admitted to the hospital. Attempt to control the ventricular rate with beta blockers resulted in recurrent significant symptomatic sinus bradycardia. A diagnosis of sick sinus syndrome was made and a dual chambered pacemaker was inserted.

Symptomatic paroxysmal atrial fibrilation was considered as a cause of the stroke but after number of consultations it was determined that the most likely cause was paradoxical embolic stroke. The patient continues with paroxysmal atrial fibrilation for which he had been on prophylactic warfarin but subsequently changed to dabigatran  as soon as it had been approved. 

The patient remains physically active. His only complaint is that xs skin folds on his neck makes him prone to nicking his skin when he shaves and that often leaves blood stains on his shirts. A plastic sugeon suggested that he could do a z-plasty to correct the problem and use a thrombin gel sponge to control the local bleeding so it wouldn't be necessary to stop the dabigatran.