Recommended Apixaban Dosing for Pulmonary Embolism
For pulmonary embolism treatment, apixaban (Eliquis) 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
- Initial dose: 10 mg twice daily for 7 days
- Maintenance dose: 5 mg twice daily for at least 3 months 1, 2
- No need for initial parenteral anticoagulation or overlap therapy, which simplifies treatment compared to warfarin 1
Extended Treatment Phase
- After completing at least 6 months of treatment at the standard dose, patients requiring extended prophylaxis can transition to 2.5 mg twice daily 1, 2
- Important: Do not inappropriately reduce the dose during the initial or maintenance treatment phases 1
Treatment Duration Considerations
- First PE with major transient/reversible risk factor: at least 3 months of anticoagulation 1
- Extended or indefinite anticoagulation recommended for:
- Recurrent venous thromboembolism
- Unprovoked PE
- PE with persistent risk factors
- PE associated with antiphospholipid antibody syndrome 1
Special Dosing Considerations
- Dose reduction (by 50%) required when coadministered with combined P-glycoprotein (P-gp) and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir) 2
- For patients with severe renal impairment, unfractionated heparin followed by vitamin K antagonists is preferred over apixaban 1
Temporary Interruption for Procedures
- Discontinue apixaban at least 48 hours prior to procedures with moderate/high bleeding risk 1, 2
- Discontinue at least 24 hours prior to procedures with low bleeding risk 1, 2
- Resume after adequate hemostasis has been established 2
Clinical Evidence
Apixaban has demonstrated effectiveness for PE treatment in clinical trials:
- The AMPLIFY trial showed apixaban was non-inferior to conventional therapy for preventing recurrent VTE (RR 0.84; 95% CI 0.60-1.18) 1, 3
- Significantly reduced major bleeding risk compared to conventional therapy (RR 0.31; 95% CI 0.17-0.55; P<0.001) 1, 3
- The AMPLIFY-J study in Japanese patients confirmed similar safety and efficacy profiles 4
Monitoring Recommendations
- Regular assessment of renal function, hepatic function, and bleeding risk for patients on extended anticoagulation 1
- If a dose is missed, take it as soon as possible on the same day and resume twice-daily administration; do not double the dose 2
Common Pitfalls to Avoid
- Using the reduced dose (2.5 mg twice daily) too early in treatment (should only be used after at least 6 months of therapy) 1
- Failing to transition from the initial 10 mg twice daily dose to the 5 mg twice daily dose after 7 days
- Inappropriate dose adjustments without considering drug interactions or specific clinical scenarios