From the Guidelines
The recommended duration of Eliquis (apixaban) treatment for pulmonary embolism (PE) is at least 3 months, with the possibility of extended therapy based on individual risk factors, as stated in the 2019 ESC guidelines 1. For most patients with a first PE provoked by a transient risk factor, 3 months of treatment is typically sufficient. However, for patients with unprovoked PE or ongoing risk factors, longer treatment durations of 6-12 months or even indefinite therapy may be recommended.
Key Considerations
- The standard dosing regimen for Eliquis in PE treatment begins with 10 mg taken orally twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of the treatment period.
- For extended treatment beyond 6 months, a reduced dose of 2.5 mg twice daily may be considered, as recommended in the 2019 ESC guidelines 1.
- The decision about treatment duration should be individualized based on the patient's bleeding risk versus recurrence risk, taking into account the patient's overall health status and medical history.
Risk Assessment
- Patients with a first episode of PE and no identifiable risk factor, or those with a first episode of PE associated with a persistent risk factor, may benefit from extended oral anticoagulation of indefinite duration, as suggested in the 2019 ESC guidelines 1.
- Regular follow-up with a healthcare provider is essential to assess treatment effectiveness and determine the appropriate duration of therapy, as well as to monitor for potential side effects and adjust the treatment plan as needed.
Treatment Goals
- The primary goal of Eliquis treatment for PE is to prevent recurrent venous thromboembolism (VTE) while minimizing the risk of bleeding complications.
- By inhibiting Factor Xa, Eliquis prevents the formation of blood clots while allowing existing clots to be gradually dissolved by the body's natural mechanisms, thereby reducing the risk of recurrent PE and improving patient outcomes.
From the Research
Recommended Duration of Eliquis (Apixaban) Treatment for Pulmonary Embolism (PE)
The recommended duration of Eliquis (apixaban) treatment for pulmonary embolism (PE) depends on various factors, including the individual risk of PE recurrence and the individual risk of bleeding.
- All patients with PE require therapeutic anticoagulation for at least three months 2.
- The decision on the duration of anticoagulation should consider both the individual risk of PE recurrence and the individual risk of bleeding 2.
- Patients with a strong transient risk factor have a low risk of recurrence, and anticoagulation can be discontinued after three months 2.
- Patients with strong persistent risk factors (such as active cancer) have a high risk of recurrence and should receive anticoagulant treatment of indefinite duration 2.
- Extended oral anticoagulation of indefinite duration should be considered for all patients with an intermediate risk of recurrence, given the favorable safety profile of non-vitamin K antagonist oral anticoagulants (NOACs) such as apixaban 2.
- Studies have shown that non-VKA oral anticoagulants, including apixaban, can be beneficial for up to 2 years without a significantly increased risk of major bleeding 3.
Factors Influencing Treatment Duration
Several factors influence the duration of Eliquis treatment for PE, including:
- Individual risk of PE recurrence
- Individual risk of bleeding
- Presence of strong transient or persistent risk factors
- Patient's overall health and medical history
Current Guidelines and Recommendations
Current guidelines recommend that all eligible patients with PE should be treated with a non-vitamin K antagonist oral anticoagulant (NOAC) in preference to a vitamin K antagonist (VKA) 2.
- Apixaban, edoxaban, and rivaroxaban are effective alternatives to treatment with low molecular weight heparins (LMWH) in patients with active cancer 2.
- The European Society of Cardiology (ESC) guidelines recommend that patients with PE should receive anticoagulation for at least three months, and the duration of treatment should be individualized based on the patient's risk factors 2.