What is the recommended duration of Eliquis (apixaban) treatment after a first episode of pulmonary embolism (primary embolism)?

From the Guidelines

For a first episode of primary pulmonary embolism (PE), Eliquis (apixaban) is typically recommended for at least 3 months, with the decision to extend treatment beyond this period based on an individualized assessment of the patient's risk factors for recurrence versus bleeding risk, as suggested by the 2020 ESC guidelines 1. The standard regimen begins with 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of the treatment period. After the initial 3 months, the decision to continue or discontinue anticoagulation should consider the patient's specific circumstances and risk profile, including the presence of transient or reversible risk factors, as outlined in the 2019 ESC guidelines 1. For patients with unprovoked PE (no identifiable risk factor), extended therapy beyond 3 months is often considered, potentially at a reduced dose of 2.5 mg twice daily for long-term prevention, as recommended in the 2020 ESC guidelines 1. Key considerations in determining the duration of anticoagulation include:

• The patient's risk of recurrence versus bleeding risk
• The presence of transient or reversible risk factors
• The patient's preference and ability to tolerate long-term anticoagulation Regular follow-up with a healthcare provider is essential to monitor for bleeding complications and to reassess the ongoing need for anticoagulation based on the patient's specific circumstances and risk profile, as emphasized in the 2019 ESC guidelines 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. However, we can look at the treatment durations and outcomes in similar contexts:

• In patients with active cancer and venous thromboembolism, extended treatment with reduced-dose apixaban for 12 months was found to be effective in preventing recurrent thromboembolic events and decreasing bleeding 2.
• For secondary prevention of venous thromboembolism, apixaban and rivaroxaban were compared to warfarin, and the study found that apixaban had a lower incidence of clinically relevant bleeding complications than warfarin 3.
• A study comparing the efficacy and safety of new oral anticoagulants in patients with atrial fibrillation found that apixaban produced significantly fewer major hemorrhages than dabigatran and rivaroxaban 4.

Key Considerations

Some key points to consider when determining the duration of Eliquis treatment:

• The risk of recurrent venous thromboembolism and the risk of anticoagulant-related bleeding should be balanced when deciding on the treatment duration.
• The treatment duration may vary depending on the individual patient's risk factors and medical history.
• Extended treatment with reduced-dose apixaban may be effective in preventing recurrent thromboembolic events and decreasing bleeding.

Treatment Outcomes

Some studies have reported the following outcomes:

• Recurrent venous thromboembolism occurred in 2.1% of patients in the reduced-dose apixaban group and 2.8% in the full-dose apixaban group 2.
• Clinically relevant bleeding occurred in 12.1% of patients in the reduced-dose apixaban group and 15.6% in the full-dose apixaban group 2.
• Apixaban had a lower incidence of clinically relevant bleeding complications than warfarin 3.