What is the recommended dosing regimen for initiating Eliquis (apixaban) in patients with Deep Vein Thrombosis (DVT)?

Apixaban Dosing Regimen for Deep Vein Thrombosis (DVT)

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

Initial Treatment Phase

The recommended dosing regimen for apixaban (Eliquis) in patients with DVT follows a specific two-phase approach:

1. Loading Phase (First 7 days)

   • Apixaban 10 mg orally twice daily for 7 days 1, 2
   • This higher initial dose ensures rapid anticoagulation effect

2. Maintenance Phase (After 7 days)

   • Apixaban 5 mg orally twice daily 1, 2
   • Continue for at least 3 months (duration depends on risk factors)

Duration of Treatment

The optimal duration of anticoagulation therapy depends on several factors:

• For provoked DVT (with temporary risk factors): 3 months of treatment
• For unprovoked DVT or persistent risk factors: Consider extended treatment
• After 6 months of initial therapy, either continue 5 mg twice daily or consider reducing to 2.5 mg twice daily for extended secondary prevention 1

Special Populations

Cancer Patients

• For patients with cancer-associated DVT, direct oral anticoagulants (DOACs) including apixaban are now considered appropriate options 1
• In cancer patients, apixaban has shown low rates of recurrent VTE compared to dalteparin 3

Renal Impairment

• No dose adjustment needed for mild to moderate renal impairment
• Use with caution in severe renal impairment (CrCl <15 mL/min) 4, 2
• Consider alternative anticoagulation in patients with severe renal dysfunction

Elderly and Low Weight Patients

• Standard DVT dosing applies regardless of age
• Unlike atrial fibrillation dosing, no dose adjustment is required for DVT treatment based on age, weight, or creatinine alone 2

Monitoring and Follow-up

• Baseline laboratory testing should include CBC with platelet count, renal and hepatic function panel 1
• Regular monitoring for signs of bleeding is essential
• No routine coagulation monitoring is required, unlike warfarin therapy

Practical Considerations

• Apixaban can be taken with or without food 2
• If a dose is missed, take it as soon as remembered on the same day, then resume the twice-daily schedule
• Do not double the dose to make up for a missed dose 2
• For temporary interruptions (e.g., surgery), discontinue apixaban at least 24-48 hours before procedures depending on bleeding risk 2

Advantages of Apixaban for DVT Treatment

• Fixed-dose regimen without need for routine laboratory monitoring
• No need for initial parenteral anticoagulation (unlike dabigatran or edoxaban) 1
• Lower risk of major bleeding compared to conventional therapy with enoxaparin/warfarin 1, 5

Potential Pitfalls and Cautions

• Premature discontinuation increases thrombotic risk 2
• Concomitant use with other anticoagulants, antiplatelet agents, or NSAIDs increases bleeding risk 4, 2
• Contraindicated in patients with active pathological bleeding 2
• Patients with gastric or gastroesophageal lesions may have increased bleeding risk with DOACs 1

The apixaban regimen for DVT offers a convenient oral option with a favorable efficacy and safety profile, eliminating the need for initial parenteral therapy and routine coagulation monitoring that was traditionally required with vitamin K antagonists.