What is the recommended dosage of Elaquis (apixaban) for pulmonary embolism (PE)?

From the Guidelines

The recommended dosage of Elaquis (apixaban) for pulmonary embolism (PE) is 10 mg taken orally twice daily for 7 days, followed by 5 mg twice daily. This dosage is based on the 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism, which compared apixaban with conventional therapy in patients with acute VTE, including those with PE 1. The study found that apixaban was non-inferior to conventional therapy for the primary efficacy outcome, with a lower risk of major bleeding.

Key Considerations

• The initial dose of 10 mg twice daily for 7 days provides intensive anticoagulation during the high-risk period, followed by a maintenance dose of 5 mg twice daily.
• Patients should take Elaquis with or without food at approximately 12-hour intervals.
• Dose adjustments may be necessary for certain populations, such as those with severe renal impairment or specific patient factors (age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL) 1.
• Kidney function should be assessed before starting treatment, and patients should be monitored for bleeding, the most common side effect of Elaquis.

Clinical Implications

The use of Elaquis in patients with PE has been shown to be effective in reducing the risk of recurrent VTE, with a lower risk of major bleeding compared to conventional therapy 1. Therefore, Elaquis can be considered a suitable treatment option for patients with PE, particularly those who are at high risk of bleeding or have difficulty managing traditional anticoagulant therapies. However, patients should be closely monitored and educated on the risks and benefits of Elaquis, as well as the importance of adhering to the prescribed dosage and treatment regimen.

From the FDA Drug Label

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. The recommended dosage of Elaquis (apixaban) for pulmonary embolism (PE) is:

• 10 mg taken orally twice daily for the first 7 days of therapy
• 5 mg taken orally twice daily after 7 days 2

From the Research

Elaquis (Apixaban) Dosage for Pulmonary Embolism (PE)

• The recommended dosage of Elaquis (apixaban) for the treatment of pulmonary embolism (PE) is not explicitly stated in the provided studies, but according to the standard treatment guidelines, apixaban is typically administered at a dose of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily 3, 4, 5.
• The dosage of apixaban may vary depending on the patient's renal function and other clinical factors, such as the presence of active cancer or a high risk of bleeding 5.
• Extended anticoagulation with apixaban at a treatment dose (5 mg twice daily) or a thromboprophylactic dose (2.5 mg twice daily) can reduce the risk of recurrent venous thromboembolism without increasing the rate of major bleeding 4.

Pharmacokinetics and Pharmacodynamics of Apixaban

• Apixaban has a rapid onset of action and predictable pharmacokinetics, allowing for a fixed-dose regimen 6, 4.
• The absolute oral bioavailability of apixaban is approximately 50%, and food does not have a clinically meaningful impact on its bioavailability 6.
• Apixaban is eliminated via multiple pathways, including metabolism, biliary excretion, and direct intestinal excretion, with approximately 27% of total apixaban clearance occurring via renal excretion 6.

Clinical Considerations for Apixaban Use in PE

• Apixaban is a non-vitamin K antagonist oral anticoagulant (NOAC) that is preferred over vitamin K antagonists (VKAs) for the treatment of PE, due to its favorable safety profile and reduced risk of bleeding 3, 5.
• The decision to extend anticoagulation with apixaban should consider both the individual risk of PE recurrence and the individual risk of bleeding 5.