From the Guidelines
Deep vein thrombosis (DVT) is typically treated with anticoagulant medications, and Eliquis (apixaban) is indeed an effective option, with a recommended dose of 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, as supported by the American Society of Hematology 2020 guidelines 1.
Treatment Overview
The treatment of DVT with Eliquis (apixaban) is based on its mechanism of action as a direct oral anticoagulant (DOAC) that inhibits Factor Xa, preventing blood clot formation while allowing existing clots to dissolve naturally.
- The initial dose of 10 mg twice daily for 7 days is crucial for quickly establishing therapeutic anticoagulation levels.
- The subsequent dose of 5 mg twice daily is used for long-term prevention of recurrent VTE, with treatment duration depending on whether the DVT was provoked by a temporary risk factor or unprovoked.
Comparison with Other Treatments
Other treatment options for DVT include different DOACs like rivaroxaban (Xarelto), dabigatran (Pradaxa), or edoxaban (Savaysa), as well as traditional warfarin therapy.
- The choice between these options should be based on patient-specific factors, including the risk of recurrent VTE, the risk of anticoagulant-related bleeding, and patient preferences.
- According to the Chest guideline and expert panel report from 2016, dabigatran, rivaroxaban, apixaban, and edoxaban are suggested over vitamin K antagonist (VKA) therapy for long-term anticoagulant therapy in patients with DVT and no cancer 1.
Patient Management
During treatment with Eliquis (apixaban), patients should:
- Stay hydrated to help prevent dehydration, which can increase the risk of blood clots.
- Avoid prolonged immobility, as this can increase the risk of developing another blood clot.
- Consider using compression stockings for symptom relief, although their use is not routinely recommended for preventing post-thrombotic syndrome (PTS) 1.
- Be aware of the bleeding risk associated with anticoagulant therapy and seek immediate medical attention if they experience any unusual bleeding, severe headaches, or worsening leg symptoms. Regular follow-up with healthcare providers is essential to monitor treatment effectiveness and determine the optimal duration of anticoagulation therapy.
From the FDA Drug Label
1.3 Treatment of Deep Vein Thrombosis Apixaban tablets are indicated for the treatment of DVT.
2 DOSAGE & ADMINISTRATION ... 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 treatment for Deep Vein Thrombosis (DVT) using Eliquis (Apixaban) 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 2
From the Research
Treatment for Deep Vein Thrombosis (DVT) using Eliquis (Apixaban)
- The treatment for DVT using apixaban involves administering the medication in various doses, with studies indicating its efficacy and safety in patients with symptomatic DVT 3.
- Apixaban, an oral direct factor Xa inhibitor, has shown promise in preventing venous thromboembolism following major orthopedic surgery, and its use in DVT treatment has been evaluated in several studies 4, 3.
- The Botticelli DVT dose-ranging study found that apixaban, administered at doses of 5 mg twice-daily, 10 mg twice-daily, or 20 mg once-daily, had a low incidence of symptomatic recurrent venous thromboembolism and asymptomatic deterioration of bilateral compression ultrasound or perfusion lung scan 3.
- The study also found that the principal safety outcome, which included major and clinically relevant non-major bleeding, occurred in 7.3% of apixaban-treated patients, with no dose response observed 3.
- Another study found that apixaban decreased coagulation activity in patients with acute DVT, with biomarkers of coagulation activity, such as D-dimer, prothrombin fragment 1+2, and thrombin-antithrombin complex, decreasing over 12 weeks of treatment 5.
- The use of apixaban in DVT treatment has been compared to traditional anticoagulant therapy, such as low molecular weight heparin followed by vitamin K antagonist, with studies indicating that apixaban has a favorable net clinical benefit 4, 3.