From the Guidelines
After a prostatectomy complicated by deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE), Eliquis (apixaban) is typically recommended for at least 3 months. The standard dosing is 10mg twice daily for the first 7 days, followed by 5mg twice daily for the remainder of treatment 1. For patients with certain risk factors (age ≥80 years, weight ≤60kg, or serum creatinine ≥1.5mg/dL), a reduced dose of 2.5mg twice daily may be appropriate after the initial 7-day period 1. Some key points to consider when treating patients with DVT and PE include:
- The circumstances in which a PE and DVT occur is the strongest predictor of likelihood of recurrence and determining this from the history is the most useful method of stratifying patient risk 1
- Patients with a PE and DVT provoked by surgery are at low risk of recurrence (annual risk < 1%) after completion of 3-months treatment with a VKA 1
- Treatment duration should be individualized based on whether this was a provoked event (related to surgery) or if there are ongoing risk factors like cancer 1
- Regular follow-up with your healthcare provider is essential to monitor for bleeding complications and to reassess the need for continued anticoagulation
- Eliquis works by inhibiting Factor Xa, preventing clot formation while allowing your body to gradually dissolve existing clots
- Avoid NSAIDs and aspirin while on Eliquis unless specifically directed by your doctor, as these increase bleeding risk 1
From the Research
Treatment of Venous Thromboembolism with Eliquis
- The treatment of venous thromboembolism (VTE) with Eliquis (apixaban) has been shown to be effective in reducing the risk of recurrent VTE and major bleeding 2, 3, 4.
- Apixaban is an oral factor Xa inhibitor with a rapid onset of action and predictable pharmacokinetics, allowing for a fixed dose regimen 2.
- Extended anticoagulation with apixaban has been shown to reduce the risk of recurrent VTE without increasing the rate of major bleeding 2, 3.
Duration of Treatment with Eliquis
- The duration of treatment with Eliquis for VTE is not explicitly stated in the provided studies, but it is generally recommended to continue anticoagulation for at least 3-6 months after an acute VTE event 5, 6.
- The decision to extend anticoagulation should be based on the individual patient's risk of recurrent VTE and major bleeding, as well as their overall health status and medical history 5, 4.
Specific Considerations for Patients with Prostate Cancer
- Patients with prostate cancer who undergo surgery are at increased risk of VTE, particularly those who undergo pelvic lymph node dissection (PLND) or radical prostatectomy 5, 6.
- The risk of VTE is highest in the first 4 weeks after surgery, and prophylactic measures may be beneficial during this period 6.
- The use of Eliquis in patients with prostate cancer has been shown to be effective in reducing the risk of recurrent VTE and major bleeding, but further studies are needed to determine the optimal duration of treatment in this population 4.