What is the loading dose and duration of Eliquis (apixaban) for the treatment of acute deep vein thrombosis (DVT)?

From the Guidelines

For the treatment of acute deep vein thrombosis (DVT), Eliquis (apixaban) is administered with an initial loading dose of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This regimen ensures rapid anticoagulation during the critical initial period when clot propagation risk is highest. The higher initial dose achieves therapeutic anticoagulation quickly, while the maintenance dose provides continued protection against clot extension and recurrence. The minimum 3-month treatment duration is necessary for most patients with DVT, though treatment may be extended based on individual risk factors for recurrence such as unprovoked DVT, persistent risk factors, or recurrent events. Apixaban works by selectively inhibiting Factor Xa, a key component in the coagulation cascade, thereby preventing thrombin formation and clot development. Patients should take Eliquis with or without food at approximately 12-hour intervals and should not suddenly discontinue the medication without consulting their healthcare provider due to increased thrombotic risk. According to the most recent and highest quality study, 1, the minimum duration of anticoagulant therapy for DVT or PE is usually 3 months.

Some key points to consider when treating acute DVT with Eliquis include:

• The importance of rapid anticoagulation to prevent clot propagation
• The need for a minimum of 3 months of treatment to reduce the risk of recurrence
• The potential for extended treatment based on individual risk factors
• The mechanism of action of apixaban in inhibiting Factor Xa and preventing thrombin formation
• The importance of not suddenly discontinuing the medication without consulting a healthcare provider.

It's also worth noting that the study 1 provides information on the pharmacokinetics and pharmacodynamics of apixaban, including its half-life and metabolism, which can inform treatment decisions. Additionally, the study 1 discusses the duration of anticoagulation and the risk of recurrence, highlighting the importance of individualized treatment plans. However, the most recent and highest quality study, 1, provides the most relevant guidance for the treatment of acute DVT with Eliquis.

From the FDA Drug Label

The recommended dose of apixaban tablets for the treatment of DVT 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 treatment for acute DVT with Eliquis (apixaban) is a loading dose of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily.

• The initial loading dose duration is 7 days.
• After the loading dose, the treatment continues with 5 mg twice daily 2.

From the Research

Treatment for Acute DVT with Eliquis (Apixaban)

• The loading dose of Eliquis (apixaban) for the treatment of acute deep vein thrombosis (DVT) is 10 mg twice daily for 7 days, followed by 5 mg twice daily 3.
• The duration of treatment with apixaban for acute DVT is typically 6 months 3.
• Apixaban has been shown to be noninferior to conventional therapy (enoxaparin followed by warfarin) for the treatment of acute venous thromboembolism, with a lower risk of major bleeding 3.
• The efficacy and safety of apixaban for the treatment of acute DVT have been demonstrated in several studies, including the AMPLIFY trial, which compared apixaban to conventional therapy in 5395 patients with acute venous thromboembolism 3.

Dosing Patterns and Efficacy

• A study of apixaban dosing patterns for treatment or prevention of thrombotic events in hospitalized patients on dialysis found that deviations from recommended dosing were common, highlighting the need for updated dosing guidance in this population 4.
• Another study found that low-dose apixaban (2.5 mg twice daily) was effective and safe for secondary prophylaxis of venous thromboembolism in patients at high risk of recurrence, with a low rate of bleeding events 5.
• Apixaban has also been shown to decrease coagulation activity in patients with acute DVT, with a similar reduction in biomarker levels compared to low-molecular-weight heparin followed by vitamin K antagonist (LMWH/VKA) 6.

Safety and Bleeding Risk

• Apixaban has been associated with a lower risk of major bleeding compared to conventional therapy, with a relative risk of 0.31 (95% CI, 0.17 to 0.55) in the AMPLIFY trial 3.
• The composite outcome of major bleeding and clinically relevant nonmajor bleeding was also lower with apixaban compared to conventional therapy, with a relative risk of 0.44 (95% CI, 0.36 to 0.55) 3.