Dosing of Apixaban (Eliquis) for DVT and PE
The recommended dosing regimen for apixaban (Eliquis) in DVT and PE is 10 mg orally twice daily for the first 7 days, followed by 5 mg orally twice daily for at least 3 months. 1, 2
Initial Treatment Phase
- First 7 days: 10 mg orally twice daily
- Maintenance phase: 5 mg orally twice daily (after the initial 7 days)
- Minimum treatment duration: 3 months (typically 6 months for unprovoked VTE)
Extended Treatment Considerations
After completing at least 6 months of initial therapy for DVT/PE, dosing options for extended secondary prevention include:
- Continue 5 mg twice daily, OR
- Reduce to 2.5 mg twice daily 2
The decision for extended therapy beyond the initial treatment period should be based on risk of recurrence versus bleeding risk.
Special Populations and Dosing Adjustments
Renal impairment:
- Use with caution in patients with CrCl 15-30 mL/min
- Avoid in severe renal impairment (CrCl <15 mL/min) 3
Drug interactions:
- For patients receiving 5 mg or 10 mg twice daily, reduce dose by 50% when coadministered with combined P-gp and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir)
- For patients already taking 2.5 mg twice daily, avoid coadministration with these inhibitors 1
Clinical Evidence Supporting This Regimen
The AMPLIFY trial demonstrated that apixaban (10 mg twice daily for 7 days, followed by 5 mg twice daily) was non-inferior to conventional therapy (enoxaparin/warfarin) for the treatment of acute VTE. Importantly, apixaban showed significantly lower rates of major bleeding (0.6% vs 1.8%) compared to conventional therapy 4, 2.
This fixed-dose regimen eliminates the need for initial parenteral anticoagulation and routine laboratory monitoring, which is a significant advantage over traditional VTE treatment with warfarin 5.
Important Clinical Considerations
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 to make up for a missed dose 1
For elective surgery or invasive procedures:
- Discontinue apixaban at least 48 hours prior to procedures with moderate/high bleeding risk
- Discontinue at least 24 hours prior to procedures with low bleeding risk 1
The recommended dosing for apixaban in DVT/PE is higher than that used for atrial fibrillation, so ensure the correct indication-specific dosing is prescribed 2
Apixaban has also shown efficacy and safety in cancer-associated VTE, with non-inferior results compared to dalteparin without increased bleeding risk 6
By following this evidence-based dosing regimen, apixaban provides an effective and safe treatment option for patients with DVT and PE with the convenience of oral administration and no need for routine coagulation monitoring.