From the Guidelines
For a first episode of primary pulmonary embolism (PE), Eliquis (apixaban) is typically recommended for at least 3 months, with a standard dosing regimen of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of the treatment period, as supported by the 2020 ESC guidelines 1. The decision to extend anticoagulation beyond 3 months should be based on an individualized assessment of the patient's risk factors for recurrence versus bleeding risk, considering the patient's preference and weighing the benefits against the risks of continued treatment, as outlined in the 2019 ESC guidelines 1. Key factors to consider include:
- The presence of transient or reversible risk factors, which may allow for discontinuation of anticoagulation after 3 months if these factors have resolved 1
- The presence of unprovoked PE or persistent risk factors, which may necessitate extended therapy beyond 3 months, potentially with a reduced dose of 2.5 mg twice daily for long-term prevention 1
- Regular follow-up with a healthcare provider is essential to reassess the risk-benefit ratio of continued anticoagulation therapy and to monitor for signs of VTE recurrence, cancer, or bleeding complications of anticoagulation 1. It is crucial to balance the need to prevent recurrent clots while minimizing bleeding complications, and the patient's bleeding risk should be assessed to identify and treat modifiable bleeding risk factors, which may influence decision-making on the duration and regimen/dose of anticoagulant treatment 1.
From the Research
Duration of Eliquis Treatment After Primary Embolism
- The optimal duration of Eliquis (apixaban) treatment after a first episode of primary embolism is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that direct oral anticoagulants (DOACs) such as apixaban are effective and safe for the treatment of pulmonary embolism (PE) and venous thromboembolism (VTE) 2, 3, 4, 5, 6.
- A study published in 2022 found that DOACs are noninferior to heparin combined with a vitamin K antagonist such as warfarin for treating PE, with a lower rate of bleeding 2.
- Another study published in 2018 found that transitioning from parenteral anticoagulation to DOACs such as apixaban or rivaroxaban after catheter-directed thrombolysis for submassive PE may decrease hospital length of stay compared to warfarin 6.
- The American College of Cardiology and American Heart Association guidelines recommend that patients with PE be treated with anticoagulation for at least 3-6 months, but the optimal duration of treatment is not well established 2.
Factors Influencing Treatment Duration
- The decision to extend or shorten the duration of Eliquis treatment should be based on individual patient factors, such as the risk of recurrent VTE and the risk of anticoagulant-related bleeding 3, 4, 5.
- Patients with a high risk of recurrent VTE may require longer-term anticoagulation, while those with a high risk of bleeding may require shorter-term treatment or alternative therapies 3, 4, 5.
- The studies suggest that apixaban and other DOACs may be safer and more effective than warfarin for long-term anticoagulation in patients with VTE, but further research is needed to determine the optimal treatment duration 3, 4, 5, 6.