From the Guidelines
For acute pulmonary embolism (PE), Eliquis (apixaban) is typically dosed at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This loading dose regimen helps achieve therapeutic anticoagulation quickly to address the acute clot, as supported by the 2014 ESC guidelines on the diagnosis and management of acute pulmonary embolism 1. Patients should take Eliquis with or without food at approximately 12-hour intervals. No routine monitoring of coagulation parameters is required, unlike warfarin. Renal function should be assessed before starting therapy, with dose adjustments needed for patients with severe renal impairment (CrCl <15 mL/min) or those on dialysis.
The most recent guidelines from 2019, developed in collaboration with the European Respiratory Society (ERS), recommend the use of non-vitamin K antagonist oral anticoagulants (NOACs) like apixaban for the treatment of PE, citing their non-inferior efficacy and possibly safer profile compared to traditional anticoagulation regimens 1. Specifically, the guidelines suggest that when oral anticoagulation is started in a patient with PE who is eligible for a NOAC, a NOAC is recommended in preference to a vitamin K antagonist (VKA) 1.
For long-term management, the guidelines recommend therapeutic anticoagulation for more than 3 months for all patients with PE, with the option for extended anticoagulation of indefinite duration in certain cases, such as patients with recurrent VTE or those with a first episode of PE and no identifiable risk factor 1. After 6 months of therapeutic anticoagulation, a reduced dose of apixaban (2.5 mg twice daily) may be considered for extended anticoagulation 1.
It's crucial to assess the patient's bleeding risk and to identify and treat modifiable bleeding risk factors, as this may influence decision-making on the duration and regimen/dose of anticoagulant treatment 1. Patients should be counseled about bleeding risks, the importance of medication adherence, and to inform healthcare providers about all medications they take, as certain drugs like strong CYP3A4 inhibitors can interact with Eliquis.
From the FDA Drug Label
- DOSAGE & ADMINISTRATION ... Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily.
The dosing for Apixaban (Eliquis) in the treatment of acute Pulmonary Embolism (PE) is:
- 10 mg taken orally twice daily for the first 7 days of therapy
- 5 mg taken orally twice daily after 7 days 2
From the Research
Dosing for Apixaban in Acute Pulmonary Embolism
- The dosing for apixaban (Eliquis) in the treatment of acute Pulmonary Embolism (PE) is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, the studies discuss the treatment options for acute PE, including direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, and edoxaban 3, 4.
- One study mentions that DOACs like apixaban allow for single drug therapy, eliminating the need for initial parenteral anticoagulation 3.
- Another study states that first-line therapy for PE consists of direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg 4.
- The studies do not provide specific dosing information for apixaban in the treatment of acute PE, but they do discuss the efficacy and safety of rivaroxaban, another DOAC, in the treatment of PE 5, 7.
Treatment Duration and Special Populations
- The duration of anticoagulation for acute PE depends on the presence of transient risk factors, with short-term courses (3 months) recommended for provoked events and extended anticoagulation for unprovoked events or those with continuing risk factors 3.
- Special populations, such as patients with renal impairment, malignancy, or obesity, require careful consideration when selecting anticoagulant therapy for PE 3.
- The studies do not provide specific guidance on dosing adjustments for apixaban in these special populations, but they do highlight the importance of individualized treatment approaches 3, 4.