From the Guidelines
For pulmonary embolism treatment, apixaban (Eliquis) is typically administered at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This regimen provides rapid anticoagulation during the critical initial period, then transitions to a maintenance dose for continued treatment, as recommended by the 2020 ACC expert consensus decision pathway for anticoagulant and antiplatelet therapy in patients with atrial fibrillation or venous thromboembolism undergoing percutaneous coronary intervention or with atherosclerotic cardiovascular disease 1.
The dosing regimen is crucial for effective treatment and minimizing risks. Key considerations include:
- Initial treatment: 10 mg orally twice daily for the first 7 days of therapy
- Maintenance treatment: 5 mg orally twice daily after the initial 7 days
- Potential dose adjustments for patients with certain risk factors, such as body weight less than 60 kg, age 80 years or older, or serum creatinine ≥1.5 mg/dL, may be necessary, although specific guidance on these adjustments is not provided in the most recent and highest quality study 1.
It's also important to consider the mechanism of action of apixaban, which works by selectively inhibiting factor Xa, preventing thrombin formation and clot development. Patients should be counseled about bleeding risks, the importance of medication adherence, and avoiding other anticoagulants unless directed by their healthcare provider. Renal function should be assessed before starting treatment and periodically thereafter, as impaired kidney function affects drug clearance, as noted in earlier studies 1.
Recent guidelines, such as the 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism, support the use of NOACs like apixaban in preference to VKAs for eligible patients, highlighting the importance of selecting the appropriate anticoagulant based on patient-specific factors 1.
From the FDA Drug Label
1.4 Treatment of Pulmonary Embolism Apixaban tablets are indicated for the treatment of PE.
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 dosing regimen for apixaban (Eliquis) in the treatment of pulmonary embolism 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
Apixaban (Eliquis) Dosing Regimen for Pulmonary Embolism Treatment
The recommended dosing regimen for apixaban (Eliquis) in the treatment of pulmonary embolism is as follows:
- Initial dose: 10 mg twice daily for 7 days 3
- Maintenance dose: 5 mg twice daily after the initial 7 days 3
Important Considerations
- Apixaban is contraindicated in patients with severe renal failure (creatinine clearance < 30 mL/min) and liver insufficiency 3
- The risk/benefit ratio of apixaban in specific subgroups deserves prospective validations 3
- Apixaban has been shown to be non-inferior to conventional treatment (enoxaparin followed by warfarin) in the treatment of venous thromboembolism, with a decreased risk of major bleeding 4, 5
Comparison with Other Anticoagulants
- Apixaban has been compared to warfarin in the treatment of venous thromboembolism, with apixaban showing a lower risk of bleeding and recurrent VTE 4
- The early time course of recurrent thromboembolism and bleeding during apixaban or enoxaparin/warfarin therapy has been studied, with apixaban showing a reduced bleeding risk 5
Historical Context
- Traditional anticoagulant agents, such as unfractionated heparin and oral anticoagulants, have been used in the prevention and treatment of pulmonary embolism 6
- New oral anticoagulants, such as rivaroxaban and apixaban, have been developed and are being used in the treatment of venous thromboembolism 3, 7