What is the optimal dose of apixaban (Apixaban) for the indefinite treatment of extensive pulmonary embolism (PE) and deep vein thrombosis (DVT)?

From the Guidelines

For indefinite treatment of extensive pulmonary embolism (PE) and deep vein thrombosis (DVT), the optimal dose of apixaban is 2.5 mg taken orally twice daily after 6 months of therapeutic anticoagulation, as recommended by the 2019 ESC guidelines 1. This dose reduction is considered after an initial treatment phase, which typically consists of 10 mg twice daily for the first 7 days, followed by a maintenance dose of 5 mg twice daily. The decision to extend anticoagulation and reduce the dose should be based on the patient's risk factors, bleeding risk, and renal function. Some key points to consider when prescribing apixaban for indefinite treatment of PE and DVT include:

• Regular monitoring of renal function, bleeding risk, and medication adherence is essential during indefinite therapy 1.
• Patients should be advised to avoid NSAIDs when possible and to inform all healthcare providers about their anticoagulation status.
• Apixaban works by directly inhibiting Factor Xa, preventing thrombin formation and clot development, making it effective for both preventing clot extension and recurrence in patients with extensive venous thromboembolism. The 2020 ACC expert consensus decision pathway also provides guidance on anticoagulation dosing for VTE, including apixaban, but the 2019 ESC guidelines provide more specific recommendations for indefinite treatment and dose reduction 1. It is essential to weigh the benefits and risks of extended anticoagulation and dose reduction on a case-by-case basis, considering the individual patient's risk factors and medical history.

From the FDA Drug Label

Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily. 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 optimal dose for apixaban to treat extensive pulmonary embolism and deep vein thrombosis indefinitely is 2.5 mg twice daily after at least 6 months of treatment for DVT or PE 2.

From the Research

Optimal Dose for Apixaban

The optimal dose for apixaban to treat extensive pulmonary embolism and deep vein thrombosis indefinitely is:

• 5 mg twice daily for the treatment dose, as stated in the study 3
• 2.5 mg twice daily for the thromboprophylactic dose, as mentioned in the study 3

Efficacy and Safety

The use of apixaban for the treatment of venous thromboembolism (VTE) has been shown to be effective and safe, with a reduced risk of major bleeding compared to conventional treatment regimens 3, 4, 5. Some key points to consider:

• Apixaban has a rapid onset of action and predictable pharmacokinetics, allowing for a fixed-dose regimen 3
• Extended anticoagulation with apixaban reduces the risk of recurrent VTE without increasing the rate of major bleeding 3
• Apixaban has been shown to be non-inferior to standard therapy, with significant reductions in major bleeding and fewer intracranial and retroperitoneal bleeding events 4

Special Populations

There are some populations in which the use of apixaban has not been extensively studied, such as:

• Patients over 75 years old 6
• Patients with cancer, low or high body weight, or poor renal function 6
• Pediatric patients and patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia 6