From the Guidelines
For acute pulmonary embolism (PE), Eliquis (apixaban) is typically dosed at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This regimen provides immediate therapeutic anticoagulation without requiring bridging with heparin or low molecular weight heparin, as supported by the 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism 1. The higher initial dose ensures rapid anticoagulation during the critical early period when clot extension and recurrence risk are highest.
Key Considerations
- Patients should take Eliquis with or without food at approximately 12-hour intervals.
- Dose adjustment is necessary for patients with significant renal impairment (creatinine clearance 15-29 mL/min) to 2.5 mg twice daily after the initial 7-day period, and Eliquis is not recommended for those with creatinine clearance below 15 mL/min, as indicated in the 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism 1.
- For elderly patients (over 80 years), those weighing less than 60 kg, or with serum creatinine ≥1.5 mg/dL, consider reducing the maintenance dose to 2.5 mg twice daily after the initial treatment period.
- Monitor for bleeding complications throughout treatment, especially in patients with additional risk factors such as concurrent antiplatelet therapy or history of bleeding.
Rationale
The dosing regimen is based on the results of clinical trials, including the study comparing apixaban with conventional therapy in patients with acute VTE, which showed that apixaban was non-inferior to conventional therapy for the primary efficacy outcome and had a lower risk of major bleeding 1. Similarly, the 2019 ESC guidelines recommend the use of NOACs, such as apixaban, as an alternative to standard treatment for acute PE, citing their non-inferior efficacy and potentially safer profile in terms of major bleeding 1.
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.
The recommended dosing for Eliquis (apixaban) in the treatment of acute Pulmonary Embolism (PE) 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 2 2 2
From the Research
Eliquis Dosing for Acute PE
- The dosing for Eliquis (apixaban) in the treatment of acute pulmonary embolism (PE) is not explicitly stated in the provided studies, but its use as a treatment option is discussed 3, 4, 5.
- Apixaban is approved for the acute treatment of deep-vein thrombosis (DVT) and pulmonary embolism (PE) as well as for the reduction in the risk of recurrent DVT and PE following initial therapy 3.
- Direct oral anticoagulants such as apixaban are noninferior for treating PE and have a lower rate of bleeding compared to heparin combined with a vitamin K antagonist such as warfarin followed by warfarin alone 4.
- The use of apixaban in special populations, such as patients over 75 years old, those with cancer, low or high body weight, or poor renal function, has not been extensively studied 3.
- Extended anticoagulation with apixaban reduces the risk of recurrent venous thromboembolism without an increase in the rate of major bleeding 5.
Treatment of Acute PE
- The treatment of acute PE typically involves initial therapy with low-molecular-weight heparin (LMWH), fondaparinux, or unfractionated heparin, followed by long-term treatment with vitamin-K antagonists (VKAs) or direct oral anticoagulants such as apixaban 6, 7.
- Thrombolysis is a widely accepted treatment strategy for patients with hemodynamic shock (massive PE) 4, 7.
- The duration of anticoagulant treatment depends on the type of PE and the balance between the risks of recurrent PE, major bleeding, and the patient's preference 7.