From the Guidelines
For patients undergoing hip replacement surgery, the recommended apixaban regimen is 2.5 mg taken orally twice daily, starting 12-24 hours after surgery and continuing for 35 days. This specific dosing and duration has been established as effective for preventing venous thromboembolism (VTE) following hip replacement, as demonstrated in the ADVANCE-3 trial 1. The first dose should be administered once hemostasis has been achieved. No dose adjustment is typically needed for most patients, though caution is warranted in those with severe renal impairment.
Key Considerations
- The extended 35-day duration is important because the risk of developing blood clots remains elevated for several weeks after hip replacement surgery.
- Apixaban works by inhibiting Factor Xa, a key component in the blood clotting cascade, thereby reducing the formation of thrombin and preventing clot formation.
- Patients should be advised to take the medication at approximately the same times each day with or without food and should not discontinue it without consulting their healthcare provider, as premature discontinuation increases thrombotic risk.
Evidence Support
The ADVANCE-3 trial 1 showed that apixaban was superior to enoxaparin for the prevention of total VTE or all-cause mortality in patients undergoing hip arthroplasty, with a relative risk of 0.36 (95% CI, 0.22-0.54; P<0.001). This trial supports the use of apixaban 2.5 mg twice daily for 35 days in this patient population.
From the FDA Drug Label
The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery. In patients undergoing hip replacement surgery, the recommended duration of treatment is 35 days.
The recommended dose and duration of Apixaban therapy following hip replacement surgery is 2.5 mg twice daily, starting 12 to 24 hours after surgery, for a duration of 35 days 2.
From the Research
Recommended Dose and Duration of Apixaban Therapy
- The recommended dose of apixaban for thromboprophylaxis after hip replacement surgery is 2.5 mg orally twice daily 3, 4, 5.
- The duration of apixaban therapy after hip replacement surgery is typically 35 days 3, 5.
- Apixaban therapy is usually initiated 12 to 24 hours after closure of the surgical wound 3.
Efficacy and Safety of Apixaban
- Apixaban has been shown to be effective in preventing venous thromboembolism (VTE) after hip replacement surgery, with a lower risk of VTE events compared to enoxaparin 3, 5.
- Apixaban has also been shown to have a similar safety profile to enoxaparin, with no significant increase in major bleeding events 3, 5.
- A meta-analysis of major venous thromboembolism and bleeding in 8464 patients from the ADVANCE-2 and ADVANCE-3 trials found that apixaban 2.5 mg twice daily was more effective than enoxaparin 40 mg once daily without increased bleeding 5.
Comparison with Other Anticoagulants
- Apixaban has been compared to low-molecular-weight heparins (LMWH) in several studies, with results showing that apixaban is equally effective and safe as LMWH twice a day, but may be superior to LMWH once a day 6.
- Emerging factor XI(a) inhibitors have shown promise as a potential strategy for VTE prophylaxis in patients undergoing major orthopedic surgery, but more research is needed to fully understand their efficacy and safety 7.