From the Guidelines
The chronic suppression dose of Eliquis (apixaban) for long-term treatment of deep vein thrombosis (DVT) is 2.5 mg taken orally twice daily, as recommended by the most recent guidelines 1. This maintenance dose typically begins after completing an initial treatment phase of 5 mg twice daily for the first 6 months following the DVT diagnosis. The reduced 2.5 mg twice daily dosing is appropriate for extended treatment beyond the initial 6-month period when continued anticoagulation is deemed necessary. Key considerations for this dosing include:
- Effective protection against recurrent DVT
- Potential reduction in bleeding risks compared to the higher initial treatment dose
- No dosage adjustment typically needed for age alone
- Dose reduction should be considered in patients with multiple risk factors, including:
- Age ≥80 years
- Body weight ≤60 kg
- Serum creatinine ≥1.5 mg/dL Patients should take Eliquis consistently at approximately 12-hour intervals with or without food and should not stop taking the medication without consulting their healthcare provider, as abrupt discontinuation increases thrombosis risk. Regular monitoring of renal function and assessment for bleeding complications is recommended during long-term therapy, as suggested by the American Society of Hematology 2020 guidelines 1.
From the FDA Drug Label
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 chronic suppression dose of Eliquis (apixaban) for DVT is 2.5 mg taken orally twice daily, after at least 6 months of treatment for DVT or PE 2.
From the Research
Chronic Suppression Dose of Eliquis for DVT
- The optimal dose of apixaban (Eliquis) for the treatment of venous thromboembolism (VTE) is still being studied, with varying results 3, 4, 5.
- A study comparing the effectiveness and safety of low versus full dose of apixaban during extended phase oral anticoagulation in patients with VTE found no detected differences in recurrent VTE or major bleeding events between patients prescribed low versus full dose apixaban 3.
- Another study found that apixaban, dabigatran, rivaroxaban, idraparinux, and vitamin K antagonists (VKAs) all reduced VTE recurrence when compared to placebo, with apixaban appearing to have a more favorable safety profile compared to other therapies 4.
- A network meta-analysis comparing the efficacy and safety of anticoagulants for the extended treatment of VTE found that apixaban had a significantly reduced risk of 'major or clinically relevant non-major bleed' compared with warfarin INR 2.0-3.0, dabigatran, and rivaroxaban 5.
- The recommended dose of apixaban for the treatment of DVT is 10mg twice daily for the first 7 days, followed by 5mg twice daily 6, 3, 4, 5.
- However, the dose of apixaban may need to be adjusted in patients with renal impairment or other comorbidities, and the decision to extend anticoagulation should be made on a case-by-case basis, taking into account the individual patient's risk of recurrent VTE and anticoagulant-related bleeding 6, 3, 4, 5.
Key Findings
- Apixaban is an effective treatment for the prevention of VTE recurrence 3, 4, 5.
- The safety profile of apixaban is favorable compared to other anticoagulants 4, 5.
- The decision to extend anticoagulation should be made on a case-by-case basis, taking into account the individual patient's risk of recurrent VTE and anticoagulant-related bleeding 6, 3, 4, 5.