Recommended Dosing of Apixaban (Eliquis) for DVT Treatment
The recommended dose of apixaban for DVT treatment is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. 1, 2
Dosing Regimen Details
Initial Treatment Phase
- Start with 10 mg orally twice daily for 7 days
- No need for initial parenteral anticoagulation (unlike dabigatran or edoxaban)
- Can be started immediately upon diagnosis
Maintenance Phase
- After 7 days, transition to 5 mg orally twice daily
- Continue for at least 3 months (duration depends on risk factors)
Extended Treatment Phase (if needed)
- For extended treatment beyond initial therapy, dose may be reduced to 2.5 mg twice daily 1, 3
- Extended therapy is recommended for patients with low-to-moderate bleeding risk 2
Special Population Considerations
Renal Impairment
- No dose adjustment needed for mild to moderate renal impairment
- Avoid in severe renal impairment (CrCl <15 mL/min) 4, 1
- Use with caution in patients with CrCl 15-30 mL/min
Hepatic Impairment
- Contraindicated in patients with severe hepatic impairment or hepatic coagulopathy
- Avoid in patients with transaminases >2 times upper limit of normal or total bilirubin >1.5 times upper limit of normal 2, 4
Elderly and Low Body Weight
- No dose adjustment needed specifically for DVT treatment based on age or weight alone
- For other indications (like atrial fibrillation), dose reduction is recommended for patients with at least two of: age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL 4, 1
Cancer Patients
- For patients with cancer-associated thrombosis, LMWH is generally preferred over apixaban, though apixaban is an acceptable alternative 2
- Apixaban may be safer than other DOACs for patients with gastric or gastroesophageal lesions 2
Efficacy and Safety Profile
Apixaban has demonstrated:
- Non-inferiority to conventional therapy (enoxaparin/warfarin) for prevention of recurrent VTE 5
- Significantly lower rates of major bleeding compared to conventional therapy (0.6% vs 1.8%) 5
- Lower rates of clinically relevant non-major bleeding 2, 5
Important Considerations
- Missed doses should be taken as soon as possible on the same day; do not double the dose 1
- Temporary interruption for surgery: discontinue at least 48 hours prior to procedures with moderate/high bleeding risk, and 24 hours prior to low-risk procedures 1
- Monitor for signs of bleeding, especially with concomitant use of medications affecting hemostasis (NSAIDs, antiplatelet agents) 4, 1
- Avoid abrupt discontinuation due to increased risk of thrombotic events 1
Apixaban offers the advantage of fixed dosing without need for routine laboratory monitoring, making it a convenient and effective option for DVT treatment with a favorable safety profile compared to traditional therapy.