What is the recommended duration for continuing Eliquis (apixaban) after a deep vein thrombosis (DVT)?

Duration of Apixaban (Eliquis) Treatment After DVT

For patients with DVT, the recommended duration of Eliquis (apixaban) treatment depends on whether the DVT was provoked or unprovoked, with provoked DVT requiring 3 months of treatment and unprovoked proximal DVT requiring indefinite anticoagulation unless bleeding risk is high. 1

Treatment Duration Based on DVT Type

Provoked DVT

• Major transient risk factors (e.g., surgery, trauma):

  • 3 months of anticoagulation is sufficient 2, 1
  • Annual recurrence risk <1% after treatment completion 1

• Minor transient risk factors (e.g., hormone therapy, pregnancy):

  • 3-6 months of anticoagulation 1
  • For hormone-associated DVT:
    • If hormone therapy is discontinued, anticoagulation for 3 months is sufficient 2
    • If hormone therapy must continue, anticoagulation should be maintained for the duration of hormone therapy 2, 1

Unprovoked DVT

• Proximal DVT (extending into popliteal vein or above):

  • Indefinite anticoagulation recommended 1
  • Annual recurrence risk >5% after stopping treatment 1
  • Continue as long as bleeding risk is not prohibitively high 2

• Calf DVT only (distal, not extending to popliteal vein):

  • 3 months of anticoagulation is sufficient 2, 1
  • Lower recurrence risk than proximal DVT 2

Dosing for Extended Treatment

• Initial treatment phase:

  • 10 mg twice daily for the first 7 days 3
  • Then 5 mg twice daily 3

• Extended treatment phase (beyond 6 months):

  • Reduced dose of 2.5 mg twice daily recommended 1, 3
  • This maintains efficacy while reducing bleeding risk 1

Assessing Bleeding Risk

Consider the following factors that increase bleeding risk:

• Advanced age (particularly >70 years) 2
• Previous bleeding episodes 2, 1
• Renal or hepatic impairment 2, 1
• Concomitant use of drugs affecting hemostasis (aspirin, NSAIDs, etc.) 2, 1
• Poor anticoagulation control or understanding 2
• Comorbidities, reduced functional capacity 1
• Recent surgery, frequent falls, or alcohol abuse 1

Important Considerations

• Never discontinue apixaban abruptly unless due to pathological bleeding or completion of planned therapy, as this increases thrombotic risk 3

• For temporary interruptions (e.g., surgery):

  • Stop apixaban 48 hours before procedures with moderate/high bleeding risk 3
  • Stop apixaban 24 hours before procedures with low bleeding risk 3
  • Restart once adequate hemostasis is established 3

• Regular monitoring of bleeding risk, drug tolerance, adherence, and renal/hepatic function is necessary for patients on indefinite anticoagulation 1

• Recurrence patterns: In patients with previous DVT, recurrence tends to manifest as PE rather than DVT, carrying higher mortality risk 1

By following these guidelines, you can optimize the duration of Eliquis treatment after DVT to minimize both recurrence risk and bleeding complications.