From the Guidelines
For the treatment of pulmonary thromboembolism (PE), the recommended dosage of apixaban is 10 mg taken orally twice daily for the first 7 days, followed by 5 mg taken orally twice daily for at least 3 months. This regimen does not require initial parenteral anticoagulation, making it convenient for patients. The higher initial dose for the first week helps achieve therapeutic anticoagulation quickly during the highest risk period for recurrent thrombosis. Apixaban should be taken with or without food at approximately 12-hour intervals.
Key Considerations
- Dose adjustments are necessary for certain patients: those with severe renal impairment (creatinine clearance 15-29 mL/min) should receive 5 mg twice daily after the initial 7-day period, and patients with two or more of the following characteristics—age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL—may need dose reduction.
- Treatment duration beyond 3 months depends on risk factors, with some patients requiring extended therapy.
- Regular monitoring of renal function and bleeding risk is essential throughout treatment, as supported by studies such as 1 and 1.
Evidence Summary
The recommendation is based on the most recent and highest quality evidence available, including studies such as the AMPLIFY trial 1, which demonstrated the efficacy and safety of apixaban in the treatment of acute venous thromboembolism, including pulmonary embolism. More recent guidelines, such as those from the American Society of Hematology 1, also support the use of apixaban for the treatment of deep vein thrombosis and pulmonary embolism, highlighting the importance of considering individual patient risk factors for recurrence and bleeding when determining the duration of anticoagulant therapy.
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. The recommended dosage of apixaban for the treatment of pulmonary thromboembolism (PE) 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 Dosage for Pulmonary Thromboembolism
- The recommended dosage of apixaban for the treatment of pulmonary thromboembolism is 10 mg twice daily for 7 days, followed by 5 mg twice daily 3, 4, 5, 6.
- This dosage regimen is based on studies that have shown apixaban to be noninferior to conventional therapy for the treatment of acute venous thromboembolism, including pulmonary embolism, and to be associated with significantly less bleeding 4, 5, 6.
- The dosage of apixaban may need to be adjusted based on certain criteria, such as age, body weight, and renal function 3.
- For patients with cancer-associated venous thromboembolism, apixaban has been shown to be noninferior to subcutaneous dalteparin, with no increased risk of major bleeding 6.
- A study is currently underway to assess the efficacy and safety of apixaban 2.5 mg vs 5 mg twice daily for secondary prevention of venous thromboembolism in cancer patients 7.
Key Considerations
- Apixaban is a direct oral anticoagulant that inhibits factor Xa, and its use has been shown to be effective and safe for the treatment of pulmonary thromboembolism 3, 4, 5, 6.
- The dosage of apixaban should be carefully considered based on individual patient factors, such as renal function and body weight 3.
- Apixaban has been shown to be associated with significantly less bleeding than conventional therapy, making it a potentially attractive option for patients at high risk of bleeding 4, 5, 6.