Is 2.5 mg of Eliquis (apixaban) an appropriate dose for Pulmonary Embolism (PE) treatment?

From the Guidelines

No, 2.5 mg of Eliquis (apixaban) is not the appropriate dose for pulmonary embolism (PE) treatment. For acute PE treatment, the recommended dosage is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, as indicated in the 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism 1. The 2.5 mg twice daily dose is only used for extended prevention after completing at least 6 months of treatment at the higher dose, or for specific situations like prevention in patients who have undergone hip or knee replacement surgery. Using an inadequate dose like 2.5 mg for initial PE treatment could be dangerous as it may not effectively prevent clot growth or recurrence. PE is a serious, potentially life-threatening condition requiring proper anticoagulation at therapeutic doses. If you're considering Eliquis for PE treatment, it's essential to follow the full treatment regimen as prescribed by your healthcare provider, which includes the higher initial dosing schedule. Some studies have evaluated the use of lower doses of apixaban for secondary prevention of recurrent VTE, but these studies were not powered for comparisons between standard and low doses, and patients with a higher risk of recurrence were excluded 1. The American Society of Hematology 2020 guidelines for management of venous thromboembolism suggest that the standard dose or the lower dose of rivaroxaban or apixaban may be used for secondary prevention of VTE, but additional research is necessary to identify which subsets of patients can safely use a lower-dose DOAC 1. In the context of PE treatment, the most recent and highest quality study, the 2014 ESC guidelines, recommends the higher initial dosing schedule of apixaban 1. Key points to consider when treating PE with Eliquis include:

• The importance of proper anticoagulation at therapeutic doses to prevent clot growth or recurrence
• The need to follow the full treatment regimen as prescribed by your healthcare provider
• The potential risks of using an inadequate dose of Eliquis for initial PE treatment
• The importance of considering the individual patient's risk factors and medical history when selecting a treatment regimen.

From the FDA Drug Label

2.1 Recommended Dose ... 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. The FDA-approved dose for treatment of PE is 10 mg twice daily for the first 7 days, then 5 mg twice daily.

• The dose of 2.5 mg is not recommended for the treatment of PE according to the label 2.

From the Research

Apixaban Dosage for PE Treatment

• The standard treatment dose of apixaban for pulmonary embolism (PE) is 5 mg twice daily 3.
• However, a thromboprophylactic dose of 2.5 mg twice daily is also used for extended anticoagulation, which reduces the risk of recurrent venous thromboembolism without increasing the rate of major bleeding 3.
• There is no direct evidence to suggest that 2.5 mg of apixaban is the standard treatment dose for PE, but it is used as a thromboprophylactic dose.
• The effectiveness and safety of apixaban in treating PE have been evaluated in several studies, which suggest that it is a simple, effective, and safe alternative to conventional treatment regimens 4, 5, 6, 7.

Considerations for Apixaban Dosage

• The dosage of apixaban may need to be adjusted based on patient characteristics, such as renal function, body weight, and age 4.
• Patients with active cancer, low or high body weight, or poor renal function may require special consideration when using apixaban 4.
• The use of apixaban in pediatric patients and patients with a history of heparin-induced thrombocytopenia or identified forms of thrombophilia has not been extensively studied 4.