From the Guidelines
To transition a patient from a heparin drip to Eliquis (apixaban) for pulmonary embolism or DVT, discontinue the heparin infusion and start Eliquis 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, as recommended by the NCCN guidelines 1. This approach is based on the latest evidence from the NCCN guidelines, which assigns a category 1 recommendation to apixaban for the treatment of DVT/PE 1. The dosing regimen is supported by clinical trials, including the ADAM VTE trial and the Caravaggio study, which found apixaban to be equivalent to or better than LMWHs in terms of efficacy and safety 1. Some key considerations when transitioning to Eliquis include:
- Ensuring the patient's renal function is adequate, as dose adjustments are needed for severe renal impairment 1
- Checking for drug interactions, particularly with strong dual inhibitors of CYP3A4 and P-gp 1
- Monitoring the patient for signs of bleeding during the transition and throughout therapy 1 The NCCN guidelines also note that apixaban may be safer than edoxaban or rivaroxaban for patients with gastric or gastroesophageal lesions, although this is a category 2B recommendation 1. Overall, the recommended dosing regimen for transitioning from a heparin drip to Eliquis is supported by high-quality evidence and should be followed to ensure effective anticoagulation and minimize the risk of bleeding complications.
From the FDA Drug Label
The recommended dose of apixaban tablets for the treatment of DVT and PE 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. Switching from anticoagulants other than warfarin (oral or parenteral) to apixaban: Discontinue the anticoagulant other than warfarin and begin taking apixaban at the usual time of the next dose of the anticoagulant other than warfarin.
For transitioning a patient from a heparin drip to Eliquis (apixaban) for pulmonary embolism or deep vein thrombosis (DVT), the dosing regimen is to discontinue the heparin drip and start apixaban at the usual time of the next dose of heparin. The recommended dose of apixaban is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily. 2
From the Research
Transitioning from Heparin Drip to Eliquis (Apixaban)
When transitioning a patient from a heparin drip to Eliquis (apixaban) for pulmonary embolism or deep vein thrombosis (DVT), the following points should be considered:
- The dosing regimen for Eliquis is typically 10 mg twice daily for 7 days, followed by 5 mg twice daily 3.
- However, the provided studies do not specifically address the dosing regimen for transitioning from a heparin drip to Eliquis.
- The studies do discuss the use of low-molecular-weight heparin (LMWH) and unfractionated heparin in the treatment of DVT and pulmonary embolism 4, 5, 6.
- One study mentions the use of rivaroxaban, another factor Xa inhibitor, in the treatment of symptomatic pulmonary embolism 3.
- The study found that a fixed-dose regimen of rivaroxaban was noninferior to standard therapy with enoxaparin followed by an adjusted-dose vitamin K antagonist 3.
Key Considerations
- The treatment of DVT and pulmonary embolism typically involves the use of anticoagulants to prevent recurrent venous thromboembolism 4, 5, 6.
- The choice of anticoagulant and dosing regimen may depend on various factors, including the patient's renal function, risk of bleeding, and other medical conditions 4, 6.
- It is essential to monitor patients closely for signs of bleeding or other adverse effects when transitioning from a heparin drip to Eliquis or other anticoagulants 5, 6.
Dosing Regimen for Eliquis
- The recommended dosing regimen for Eliquis is:
- 10 mg twice daily for 7 days
- 5 mg twice daily thereafter 3
- However, this regimen may need to be adjusted based on the patient's individual needs and medical conditions.