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, as stated in the 2020 ESC guidelines 1. The standard treatment 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 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 vs. risks of continuing treatment, as recommended by 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 suggested by the 2020 ESC guidelines 1. Some key points to consider in the management of PE include:

• 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.
• Regular monitoring for bleeding complications is essential throughout treatment.
• The approach balances the need to prevent recurrent clots while minimizing bleeding risks, as Eliquis works by inhibiting Factor Xa in the coagulation cascade, thereby preventing thrombus formation.
• Patients with transient risk factors like surgery or immobilization may safely discontinue after 3 months, while those with persistent risk factors or recurrent events typically require longer treatment, as recommended by the 2020 ESC guidelines 1. It is also important to note that extended oral anticoagulation of indefinite duration should be considered for patients with a first episode of PE and no identifiable risk factor, or for those with a first episode of PE associated with a persistent risk factor other than antiphospholipid antibody syndrome, as stated in the 2020 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 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 venous thromboembolism (VTE) and pulmonary embolism (PE) 2, 3, 4, 5, 6.
• A study published in 2022 found that extended treatment with a reduced dose of apixaban was noninferior to full-dose apixaban for the prevention of recurrent VTE in patients with active cancer 3.
• Another study published in 2021 found that apixaban and rivaroxaban had lower rates of bleeding events compared to warfarin in patients with VTE 4.
• The American College of Cardiology and American Heart Association guidelines recommend that patients with VTE be treated with anticoagulation for at least 3 months, and that the decision to extend anticoagulation be based on the patient's risk of recurrent VTE and anticoagulant-related bleeding 2.

Factors Influencing Treatment Duration

• The decision to extend Eliquis treatment after a first episode of primary embolism should be based on the patient's individual risk factors, such as the presence of active cancer, history of VTE, and risk of anticoagulant-related bleeding 3, 4, 5, 6.
• The patient's renal function, liver function, and concomitant medications should also be considered when determining the treatment duration 2, 3, 4, 5, 6.
• Regular monitoring of the patient's condition and adjustment of the treatment plan as needed is crucial to minimize the risk of recurrent VTE and anticoagulant-related bleeding 2, 3, 4, 5, 6.