From the FDA Drug Label
1.5 Reduction in the Risk of Recurrence of DVT and PE Apixaban tablets are indicated to reduce the risk of recurrent DVT and PE following initial therapy.
2.4 Converting from or to apixaban If anticoagulation with apixaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant
2 DOSAGE & ADMINISTRATION 2.1 Recommended Dose Reduction in the Risk of Recurrence of DVT and PE The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE
The recommended duration of treatment with apixaban for patients with multiple PE and DVT is not explicitly stated in the label. However, it is indicated that apixaban should be taken at a dose of 2.5 mg twice daily after at least 6 months of treatment for DVT or PE to reduce the risk of recurrence. The decision to extend or stop treatment should be made on a case-by-case basis, considering the individual patient's risk of recurrent thromboembolic events and bleeding risk 1.
From the Research
The duration of Eliquis (apixaban) treatment after multiple pulmonary embolisms (PE) and deep vein thrombosis (DVT) is typically indefinite or lifelong, with a standard dose of 5 mg twice daily, as supported by the most recent study 2. This recommendation is based on the understanding that having multiple clotting events indicates an underlying tendency toward hypercoagulability, and stopping anticoagulation would likely result in additional dangerous clots. Some key points to consider include:
- The risk of future clots remains high in patients with recurrent blood clots, especially unprovoked ones, making extended anticoagulation necessary 3, 4.
- Regular follow-up with a healthcare provider is essential to monitor for any complications, assess kidney function, and ensure the medication remains appropriate 5.
- While on Eliquis, patients should avoid activities with high bleeding risk, inform all healthcare providers about their medication, and wear medical alert identification 6. It's also important to note that some patients may require periodic reassessment of their bleeding risk versus clot risk, but most with multiple events will need to continue the medication permanently. The most recent study 2 provides evidence that extended anticoagulation with reduced-dose apixaban is noninferior to full-dose apixaban for the prevention of recurrent venous thromboembolism, and the reduced dose leads to a lower incidence of clinically relevant bleeding complications. However, the standard dose for long-term treatment is still 5 mg twice daily, and patients should be closely monitored for any complications. Overall, the decision to extend anticoagulation should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history.