What is the recommended dosing for Eliquis (apixaban) in a patient with Deep Vein Thrombosis (DVT)?

Apixaban Dosing for Deep Vein Thrombosis (DVT)

For patients with DVT, apixaban should be administered at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. 1, 2

Initial Treatment Phase

The FDA-approved dosing regimen for apixaban in DVT treatment consists of two phases:

1. Initial phase (first 7 days):

   • 10 mg orally twice daily 1
   • No need for initial parenteral anticoagulation (unlike dabigatran or edoxaban) 2

2. Maintenance phase (after 7 days):

   • 5 mg orally twice daily 1
   • Continue for at least 3 months 2

Extended Treatment Phase

For patients requiring extended anticoagulation beyond the initial 3-6 months:

• Recommended dose: 2.5 mg twice daily 2, 1
• This reduced dose has been shown to be effective for preventing recurrent VTE while minimizing bleeding risk 2, 3
• The decision to continue extended therapy should be reevaluated at least annually 2

Dose Adjustments

• No dose adjustment is typically needed for:

  • Age (unless ≥80 years with other risk factors)
  • Mild to moderate renal impairment
  • Body weight (unless ≤60 kg with other risk factors) 4

• Dose reduction (by 50%) is recommended when apixaban is coadministered with:

  • Combined P-glycoprotein (P-gp) and strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) 1

• Avoid use in:

  • Severe renal impairment (CrCl <15 mL/min)
  • Severe hepatic impairment or hepatic coagulopathy 4, 1

Clinical Evidence

The AMPLIFY trial demonstrated that apixaban was noninferior to standard anticoagulant therapy (enoxaparin/warfarin) for preventing recurrent VTE, with significantly lower rates of major bleeding 2. This supports the efficacy and safety of the recommended dosing regimen.

Special Considerations

• Missed dose: Take as soon as possible on the same day and resume twice-daily schedule; do not double the dose 1
• Temporary interruption for surgery: Discontinue at least 48 hours prior to procedures with moderate/high bleeding risk, or 24 hours for low bleeding risk procedures 1
• Cancer-associated thrombosis: Low molecular weight heparin is generally preferred over apixaban, though apixaban is an acceptable alternative 2

Monitoring

• No routine coagulation monitoring is required
• Regular assessment of renal and hepatic function is recommended
• Monitor for signs of bleeding, including unexplained bruising, blood in urine or stool, and unusual headaches or dizziness 4

Potential Adverse Effects

• Major bleeding (though rates are lower than with conventional therapy)
• Rare cases of leukocytoclastic vasculitis have been reported 5

The recommended dosing regimen balances efficacy in preventing recurrent VTE with minimizing bleeding risk, making apixaban a safe and effective option for DVT treatment.