Is Eliquis (apixaban) 5 mg twice a day sufficient for venous thromboembolism (VTE) prophylaxis in a patient post-right hip surgery without low molecular weight heparin (LMWH) like Lovenox (enoxaparin)?

From the Guidelines

No, Eliquis (apixaban) 5 mg twice a day is not the appropriate dose for venous thromboembolism (VTE) prophylaxis in a patient post-right hip surgery, as the recommended dose is 2.5 mg twice a day, starting 12 to 24 hours after surgery, and continuing for 35 days post-operatively. According to the study by the American College of Chest Physicians 1, apixaban has been evaluated for VTE prevention in patients undergoing hip arthroplasty, and the recommended dose regimen is 2.5 mg bid, which was administered for 35 days in those undergoing hip arthroplasty. The study found that apixaban was superior to enoxaparin for the prevention of total VTE or all-cause mortality in patients undergoing hip arthroplasty, with a lower rate of major or clinically relevant nonmajor bleeding. Key points to consider when prescribing apixaban for VTE prophylaxis include:

• Starting the medication 12 to 24 hours after surgery
• Continuing the medication for 35 days post-operatively
• Monitoring renal function, as dose adjustments may be needed for severe renal impairment
• Assessing patients for bleeding risk factors before starting therapy
• Advising patients to take the medication consistently at approximately 12-hour intervals and not to stop it without consulting their healthcare provider. It is essential to follow the recommended dosing regimen to ensure effective VTE prophylaxis and minimize the risk of bleeding complications.

From the FDA Drug Label

The recommended dose of apixaban tablets for prophylaxis of Deep Vein Thrombosis 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 use of Eliquis (apixaban) 5 mg twice a day for VTE prophylaxis in a patient post-right hip surgery is not appropriate as the recommended dose for this indication is 2.5 mg twice daily. Additionally, there is no mention of omitting low molecular weight heparin (LMWH) like Lovenox (enoxaparin) in the context of hip replacement surgery, but the label does specify the dose of apixaban for this condition, implying that apixaban can be used alone for VTE prophylaxis in this setting at the recommended dose of 2.5 mg twice daily 2.

From the Research

Venous Thromboembolism Prophylaxis Post-Right Hip Surgery

The use of Eliquis (apixaban) 5 mg twice a day for venous thromboembolism (VTE) prophylaxis in a patient post-right hip surgery without low molecular weight heparin (LMWH) like Lovenox (enoxaparin) can be evaluated based on the following points:

• Efficacy of Apixaban: Studies have shown that apixaban is effective in preventing VTE in patients undergoing major orthopedic surgery, including hip replacement 3.
• Comparison with LMWH: Research has compared the efficacy of LMWH (such as enoxaparin) with other anticoagulants, including apixaban, in preventing VTE in orthopedic surgery patients. While LMWH has been shown to be effective, apixaban has also demonstrated efficacy in this setting 4, 5.
• Bleeding Risks: The risk of bleeding is a concern with any anticoagulant therapy. Studies have shown that apixaban may have a lower risk of major bleeding compared to LMWH in some cases 3, 6.
• Guideline Recommendations: Current guidelines recommend the use of anticoagulant prophylaxis, including apixaban, for patients undergoing major orthopedic surgery, including hip replacement.

Key Considerations

Some key considerations when evaluating the use of Eliquis 5 mg twice a day for VTE prophylaxis post-right hip surgery include:

• Patient-Specific Factors: The patient's individual risk factors for VTE and bleeding should be taken into account when selecting an anticoagulant regimen.
• Surgical Factors: The type of surgery, anesthesia used, and surgical technique may also influence the choice of anticoagulant.
• Monitoring and Follow-Up: Regular monitoring and follow-up are essential to ensure the patient is receiving adequate VTE prophylaxis and to minimize the risk of bleeding complications.

Evidence Summary

In summary, the available evidence suggests that Eliquis 5 mg twice a day may be a suitable option for VTE prophylaxis in patients post-right hip surgery, particularly in those with a high risk of VTE and a low risk of bleeding 4, 5, 3, 6, 7. However, the decision to use apixaban or another anticoagulant should be made on a case-by-case basis, taking into account individual patient factors and surgical considerations.