From the Guidelines
The standard starting dose of Eliquis (apixaban) for deep vein thrombosis (DVT) treatment is 10 mg taken orally twice daily for the first 7 days, followed by 5 mg twice daily thereafter. This dosing regimen is based on the most recent and highest quality study available, which demonstrates the efficacy and safety of apixaban in treating DVT 1. The higher initial dose helps establish therapeutic anticoagulation quickly to address the acute clot. After the initial treatment period, patients typically continue on the 5 mg twice daily maintenance dose for at least 3 months, though the total duration depends on individual risk factors and whether the DVT was provoked or unprovoked.
Some key points to consider when prescribing apixaban for DVT treatment include:
- Taking Eliquis at approximately the same times each day with or without food
- Patients with certain risk factors such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL may require dose adjustments
- Kidney function should be assessed before starting treatment
- Common side effects include increased risk of bleeding, so patients should avoid other blood thinners unless specifically prescribed together and should inform healthcare providers about Eliquis use before any procedures. The efficacy and safety of apixaban in DVT treatment have been demonstrated in several studies, including the AMPLIFY trial, which showed that apixaban was noninferior to enoxaparin/warfarin in preventing recurrent VTE or VTE-related death 1. However, the most recent and highest quality study available is the 2021 ACC expert consensus decision pathway, which recommends the above-mentioned dosing regimen for apixaban in DVT treatment 1.
From the FDA Drug Label
The recommended dose of apixaban tablets for the treatment of DVT is 10 mg taken orally twice daily for the first 7 days of therapy. The starting dose of Eliquis (apixaban) for DVT is 10 mg twice daily for the first 7 days of therapy 2.
- The dose is then reduced to 5 mg twice daily after 7 days.
- For the reduction in the risk of recurrence of DVT, the recommended dose is 2.5 mg twice daily after at least 6 months of treatment for DVT 2.
From the Research
Eliquis Dose Starting for DVT
- The studies provided do not specifically mention the starting dose of Eliquis (apixaban) for Deep Vein Thrombosis (DVT) 3, 4, 5, 6, 7.
- However, it is mentioned that apixaban and rivaroxaban are direct oral anticoagulants (DOACs) that are recommended as the first line of treatment for proximal DVT of the lower limbs, with no preference for one DOAC over another 3.
- The studies compare the efficacy and safety of apixaban and rivaroxaban in the treatment of VTE, but do not provide information on the starting dose of Eliquis for DVT 4, 5, 6, 7.
- It is worth noting that the treatment of proximal DVT includes an initial management phase, a primary treatment phase, and a secondary treatment phase, and that anticoagulant drugs, including DOACs, are the mainstay of treatment 3.
Comparison of Apixaban and Rivaroxaban
- A systematic review and meta-analysis of observational studies found that apixaban was associated with a significantly lower risk of major bleeding compared to rivaroxaban for the treatment of VTE 6.
- Another study found that apixaban seemed to be more effective than rivaroxaban in preventing the development of recurrent VTE and major bleeding events 4.
- A retrospective cohort study found that rivaroxaban exhibited comparable efficacy to warfarin for the anticoagulant treatment of unusual site DVT, associated with a lower risk of bleeding complications and major bleeding 5.
- A study on the treatment of upper extremity DVT with apixaban and rivaroxaban found that both drugs appeared to be as safe and effective as LMWH/warfarin 7.