Duration of Eliquis (Apixaban) for DVT Treatment
For deep vein thrombosis (DVT), Eliquis (apixaban) should be administered for at least 3 months initially, with the decision to extend therapy beyond this period based on whether the DVT was provoked by a transient risk factor or was unprovoked. 1
Initial Treatment Phase
- All patients with acute DVT should receive a 3-month treatment phase of anticoagulation 1
- Apixaban dosing for DVT treatment:
- Initial 7 days: 10 mg twice daily
- Remainder of treatment period: 5 mg twice daily 2
Extended Treatment Recommendations
The duration of anticoagulation beyond the initial 3 months depends on the circumstances of the DVT:
DVT with major transient risk factor (e.g., recent surgery, trauma):
- Recommend AGAINST extended anticoagulation beyond 3 months 1
- Stop therapy after completing the 3-month treatment phase
DVT with minor transient risk factor:
- Suggest AGAINST extended anticoagulation beyond 3 months 1
- Consider stopping therapy after completing the 3-month treatment phase
Unprovoked DVT or DVT with persistent risk factor (e.g., active cancer):
Special Considerations
- Cancer patients: Consider LMWH over apixaban for at least 6 months or until resolution of underlying disease 6
- Recurrent DVT: Patients with a second unprovoked DVT have a high risk of recurrence and usually require indefinite anticoagulation 7
- Risk assessment: The decision for extended therapy should be reevaluated at least annually and at times of significant health status changes 1
Risk Factors for Recurrence
Higher risk of recurrence (favoring extended therapy) includes:
- Male gender
- Unprovoked proximal DVT
- Active cancer
- Second episode of unprovoked VTE 7
- Positive D-dimer testing 1 month after stopping anticoagulation 7
Important Caveats
- Extended anticoagulation does not have a predefined stop date, but most studies monitored patients for 2-4 years 1
- Patients receiving extended therapy should have their risk-benefit balance reassessed at least annually 1
- For patients who cannot receive a DOAC for extended therapy, vitamin K antagonists (warfarin) may be considered 1
- Avoid premature discontinuation in unprovoked DVT cases, as the risk of recurrence exceeds 5% annually 3
The evidence strongly supports a minimum 3-month treatment duration for all DVT patients, with the decision to extend therapy beyond this period based primarily on whether the DVT was provoked by a transient risk factor or was unprovoked.