Apixaban (Eliquis) Treatment Regimen for Deep Vein Thrombosis
For deep vein thrombosis (DVT) treatment, apixaban (Eliquis) should be administered at 10 mg orally twice daily for the first 7 days, followed by 5 mg orally twice daily for at least 3 months. 1, 2
Initial Treatment Phase
The treatment of DVT with apixaban follows a specific dosing schedule:
- First 7 days: 10 mg orally twice daily
- After 7 days: 5 mg orally twice daily
- Minimum treatment duration: 3 months 2, 1
This fixed-dose regimen eliminates the need for initial parenteral anticoagulant therapy and laboratory monitoring, which is a significant advantage over traditional treatment approaches 3.
Extended Treatment Phase
After completing the initial 3-month treatment period, all patients should be assessed for extended-phase therapy based on risk factors:
- For unprovoked DVT or DVT with persistent risk factors: Continue anticoagulation beyond the initial 3 months 2
- For DVT with major transient risk factor: Stop anticoagulation after 3 months 2
- For extended therapy beyond 6 months: Consider reduced dose of 2.5 mg twice daily 2
Special Considerations
Renal Impairment
- No dose adjustment needed for mild to moderate renal impairment
- Avoid in patients with severe renal impairment (CrCl <15 mL/min) 1
- Use with caution in patients with CrCl 15-29 mL/min 1
Drug Interactions
- Reduce dose by 50% when coadministered with drugs that are combined P-glycoprotein (P-gp) and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) 1
- If already on 2.5 mg twice daily, avoid coadministration with these inhibitors 1
Temporary Interruption for Procedures
- Discontinue apixaban at least 48 hours prior to elective surgery or invasive procedures with moderate/high bleeding risk
- Discontinue at least 24 hours prior to procedures with low bleeding risk
- Restart after adequate hemostasis has been established 1
Efficacy and Safety
Apixaban has demonstrated comparable efficacy to conventional therapy (enoxaparin/warfarin) for DVT treatment with significantly less bleeding:
- Similar rates of recurrent VTE (2.3% vs 2.7%) 4
- Significantly lower rates of major bleeding (0.6% vs 1.8%) 4
- Lower rates of clinically relevant non-major bleeding (4.3% vs 9.7%) 4
In real-world studies, apixaban showed 27-39% lower risk of major bleeding and 25-39% lower risk of recurrent VTE compared to warfarin across various patient subgroups 5.
Cancer-Associated DVT
For patients with cancer-associated DVT, apixaban (10 mg twice daily for 7 days followed by 5 mg twice daily) has been shown to be non-inferior to dalteparin (a low molecular weight heparin) without increased risk of major bleeding 6.
Common Pitfalls to Avoid
Premature discontinuation: Stopping apixaban prematurely increases thrombotic risk. If discontinuation is necessary for reasons other than bleeding or completion of therapy, consider bridging with another anticoagulant 1.
Missed doses: If a dose is missed, take it as soon as possible on the same day and resume twice-daily dosing. Do not double the dose to make up for a missed dose 1.
Failure to assess for extended therapy: Always evaluate the need for continued anticoagulation after the initial 3-month treatment period based on whether the DVT was provoked or unprovoked 2, 7.
Incorrect dosing with drug interactions: Failure to adjust dosing when used with strong CYP3A4 inhibitors can lead to increased bleeding risk 1.
By following this treatment regimen, apixaban provides an effective, convenient, and safe option for DVT treatment with reduced bleeding risk compared to traditional therapy.