What is the recommended regimen for Eliquis (apixaban) for Deep Vein Thrombosis (DVT) prophylaxis after hip surgery?

From the Guidelines

For DVT prophylaxis after hip surgery, the recommended regimen for Eliquis (apixaban) is 2.5 mg taken orally twice daily, starting 12-24 hours after surgery and continuing for 35 days. This dosing schedule has been established to provide optimal protection during the high-risk period following hip replacement surgery, as demonstrated in the ADVANCE-3 trial, where apixaban was superior to enoxaparin in preventing total VTE or all-cause mortality in patients undergoing hip arthroplasty 1. The first dose should be initiated once hemostasis has been established to balance the risk of bleeding with the need for thromboprophylaxis. Some key points to consider when prescribing apixaban for DVT prophylaxis after hip surgery include:

• Apixaban works by selectively inhibiting Factor Xa, which interrupts the blood coagulation cascade and prevents thrombin formation and subsequent clot development, providing effective anticoagulation while maintaining a favorable bleeding risk profile compared to some alternatives 1.
• No routine monitoring of coagulation parameters is required during apixaban therapy, making it convenient for post-discharge use.
• Dose adjustments may be necessary for patients with severe renal impairment, low body weight (less than 60 kg), or those over 80 years of age.
• Patients should be advised to take missed doses as soon as remembered unless it's close to the next scheduled dose, and they should not discontinue the medication without consulting their healthcare provider. The efficacy and safety of apixaban in this context have been well-established, with rates of major or clinically relevant nonmajor bleeding numerically lower with apixaban than with enoxaparin in the ADVANCE-3 trial 1.

From the FDA Drug Label

The recommended dose of apixaban tablets for the prophylaxis of deep vein thrombosis (DVT) following hip or knee replacement surgery is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery. In patients undergoing hip replacement surgery, the recommended duration of treatment is 35 days.

The recommended regimen for Eliquis (apixaban) for DVT prophylaxis after hip surgery is 2.5 mg twice daily, starting 12 to 24 hours after surgery, for a duration of 35 days 2.

From the Research

Eliquis (Apixaban) Regimen for DVT Prophylaxis

• The recommended regimen for Eliquis (apixaban) for Deep Vein Thrombosis (DVT) prophylaxis after hip surgery is not explicitly stated in the provided studies.
• However, according to the study 3, apixaban is approved for VTE prophylaxis and has been shown to be safe and effective for VTE prophylaxis after primary total hip and total knee arthroplasties.
• The American College of Chest Physicians guidelines, as mentioned in the study 4, recommend that patients receive at least 10 to 14 days of a prophylaxis agent, including apixaban, after total hip or total knee arthroplasty.

Dosage and Duration

• The study 3 does not specify the exact dosage and duration of apixaban for DVT prophylaxis after hip surgery.
• However, it is mentioned that apixaban is prescribed for postoperative VTE prophylaxis for one of the following indications: high risk for VTE, previously on apixaban, and contraindication to the use of aspirin.

Safety and Efficacy

• The study 3 found that the use of apixaban for VTE prophylaxis after primary THA and TKA in patients at high risk for VTE, in patients previously on apixaban, and in patients with a contraindication to the use of aspirin is associated with a low risk of VTE and bleeding complications.
• The study 4 mentions that the selection of an agent for prophylaxis against venous thromboembolism (VTE) is a balance between efficacy and safety, and that validated risk stratification protocols are essential to identify the safest and most effective regimen for VTE prophylaxis for individual patients.