From the Guidelines
For a provoked pulmonary embolism (PE), patients should be treated with apixaban for at least 3 months, as recommended by the 2019 ESC guidelines 1. The standard dosing regimen is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of the treatment period. After completing the initial 3 months, treatment should be discontinued if the provoking risk factor has resolved and there are no other ongoing risk factors for recurrence, as stated in the guidelines 1. However, some patients may require longer treatment if they have ongoing risk factors or if the provoking factor cannot be fully eliminated. The decision to extend treatment beyond 3 months should be based on an individualized assessment of the patient's bleeding risk versus the risk of recurrent thrombosis. Key considerations for extending treatment include:
- The presence of ongoing risk factors for recurrence
- The patient's bleeding risk, which should be assessed using prediction models 1
- The patient's ability to tolerate anticoagulant therapy If extended oral anticoagulation is decided after PE in a patient without cancer, a reduced dose of apixaban (2.5 mg twice daily) should be considered after 6 months of therapeutic anticoagulation, as recommended by the guidelines 1. It is essential for patients to consult with their healthcare provider before discontinuing apixaban to ensure the timing is appropriate and to discuss any symptoms that might suggest recurrent thrombosis.
From the FDA Drug Label
1.4 Treatment of Pulmonary Embolism Apixaban tablets are indicated for the treatment of PE.
- DOSAGE & ADMINISTRATION 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.
2.4 Converting from or to apixaban ... If anticoagulation with apixaban is discontinued for a reason other than pathological bleeding or completion of a course of therapy, consider coverage with another anticoagulant
The duration of treatment for a provoked PE is not explicitly stated in the label. However, for the treatment of PE, the recommended dose is 10 mg twice daily for the first 7 days, then 5 mg twice daily. Additionally, for the reduction in the risk of recurrence of DVT and PE, the recommended dose is 2.5 mg twice daily after at least 6 months of treatment for DVT or PE 2.
Given this information, a conservative clinical decision would be to treat for at least 6 months for a provoked PE, then reassess the need for continued anticoagulation.
From the Research
Duration of Apixaban Treatment for Provoked PE
- The ideal duration of apixaban treatment for provoked pulmonary embolism (PE) is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, the studies suggest that the treatment of PE with direct oral anticoagulants (DOACs) such as apixaban is generally recommended for an extended period 3, 6.
- The decision to extend anticoagulation therapy should be based on the individual patient's risk of recurrent PE and the risk of anticoagulant-related bleeding 4, 6.
- The studies do not provide a specific duration for apixaban treatment, but they do mention that the treatment should be continued until the risk of recurrent PE is low and the risk of bleeding is acceptable 3, 6.
- Further research is needed to determine the optimal duration of apixaban treatment for provoked PE, as well as to identify specific patient subgroups that may benefit from extended or shortened treatment durations 7.