From the Guidelines
For initial deep vein thrombosis (DVT) treatment with Eliquis (apixaban), the recommended protocol is 10 mg taken orally twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, as supported by the most recent guidelines 1. This medication should be taken with or without food at approximately 12-hour intervals. Before starting Eliquis, confirm the diagnosis with appropriate imaging and ensure there are no contraindications such as active bleeding, severe renal impairment (CrCl <15 mL/min), or hypersensitivity to apixaban.
Key Considerations
- Baseline complete blood count, renal and liver function tests should be obtained 1.
- Patients should be counseled about bleeding risks, the importance of medication adherence, and to avoid other anticoagulants or NSAIDs without medical consultation.
- They should also be informed about signs of bleeding that warrant immediate medical attention.
Mechanism and Efficacy
Eliquis works by inhibiting Factor Xa, preventing thrombin formation and clot development, making it effective for both treatment and prevention of recurrent DVT, as shown in several clinical trials 1.
Duration of Therapy
The duration of therapy beyond 3 months depends on the patient's risk factors for recurrence and bleeding risk, requiring individualized assessment.
Alternative Options
Other direct oral anticoagulants (DOACs) such as edoxaban, dabigatran, and rivaroxaban may also be considered, but apixaban is a preferred option due to its efficacy and safety profile 1.
From the FDA Drug Label
- 3 Treatment of DVT and PE and Reduction in the Risk of Recurrence of DVT and PE Efficacy and safety of apixaban for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following 6 to 12 months of anticoagulant treatment was derived from the AMPLIFY and AMPLIFY-EXT studies Both studies were randomized, parallel-group, double-blind trials in patients with symptomatic proximal DVT and/or symptomatic PE. The primary objective of AMPLIFY was to determine whether apixaban was noninferior to enoxaparin/warfarin for the incidence of recurrent VTE (venous thromboembolism) or VTE- related death Patients with an objectively confirmed symptomatic DVT and/or PE were randomized to treatment with apixaban 10 mg twice daily orally for 7 days followed by apixaban 5 mg twice daily orally for 6 months, or enoxaparin 1 mg/kg twice daily subcutaneously for at least 5 days (until INR ≥2) followed by warfarin (target INR range 2.0-3. 0) orally for 6 months.
The initial DVT Eliquis protocol is apixaban 10 mg twice daily orally for 7 days, followed by apixaban 5 mg twice daily orally for 6 months 2.
From the Research
Initial DVT Eliquis Protocol
There is no direct evidence for an "Eliquis protocol" in the provided studies, as Eliquis is another name for apixaban, and the studies mention apixaban in the context of its use for treating deep vein thrombosis (DVT) and pulmonary embolism (PE).
- The studies compare apixaban with other anticoagulants such as rivaroxaban, warfarin, and low molecular weight heparin (LMWH) in terms of efficacy and safety for DVT and PE treatment 3, 4, 5, 6.
- Apixaban has been shown to be effective in reducing the risk of recurrent VTE and major bleeding events compared to rivaroxaban and warfarin 3, 5.
- A study comparing apixaban and rivaroxaban for the treatment of upper extremity DVT found that both drugs were safe and effective, with no significant difference in recurrent VTE or major bleeding events 6.
- Another study found that apixaban was associated with a lower rate of major bleeding compared to warfarin in patients with severe renal failure 3.
- The use of apixaban for the prophylaxis and treatment of DVT and PE has been reviewed, and it has been found to be a reasonable alternative to traditional anticoagulant therapy 4.
Key Findings
- Apixaban is effective in reducing the risk of recurrent VTE and major bleeding events 3, 5.
- Apixaban is safe and effective for the treatment of upper extremity DVT 6.
- Apixaban may be a cost-effective alternative to traditional anticoagulant therapy for DVT and PE treatment 7.
Comparison with Other Anticoagulants
- Apixaban has been compared with rivaroxaban, warfarin, and LMWH in terms of efficacy and safety for DVT and PE treatment 3, 4, 5, 6.
- Apixaban has been found to be more effective than rivaroxaban in preventing recurrent VTE and major bleeding events 5.
- Apixaban has been found to be as safe and effective as LMWH/warfarin for the treatment of upper extremity DVT 6.