What is the duration of treatment with Eliquis (apixaban) for Pulmonary Embolism (PE)?

From the Guidelines

The duration of treatment with Eliquis (apixaban) for Pulmonary Embolism (PE) should be at least 3 months, with extended treatment considered for patients with unprovoked PE, recurrent VTE, or persistent risk factors, and a reduced dose of 2.5 mg twice daily may be considered after 6 months of therapeutic anticoagulation. When determining the duration of Eliquis treatment for PE, several factors must be considered, including the presence of transient or reversible risk factors, the patient's bleeding risk, and their history of recurrent VTE 1. For patients with a first PE secondary to a major transient or reversible risk factor, discontinuation of therapeutic oral anticoagulation is recommended after 3 months 1. However, for patients with unprovoked PE or those with ongoing risk factors, extended oral anticoagulation of indefinite duration should be considered 1. The decision to extend treatment should be based on a careful assessment of the patient's individual risk factors, including their bleeding risk, and should be regularly reassessed to ensure that the benefits of continued treatment outweigh the risks 1. Key considerations for extended treatment include:

• Unprovoked PE
• Recurrent VTE
• Persistent risk factors
• Active cancer
• Genetic clotting disorders Regular follow-up with a healthcare provider is essential to reassess the need for continued therapy, monitor for complications, and adjust treatment as needed 1. It is also important to note that stopping Eliquis should never be done without medical supervision due to the risk of developing new clots 1. In terms of dosing, the standard Eliquis dosage for PE treatment is 10mg twice daily for the first 7 days, followed by 5mg twice daily for the remainder of treatment, but a reduced dose of 2.5 mg twice daily may be considered after 6 months of therapeutic anticoagulation 1.

From the FDA Drug Label

14.3 Treatment of DVT and PE and Reduction in the Risk of Recurrence of DVT and PE Efficacy and safety of apixaban for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following 6 to 12 months of anticoagulant treatment was derived from the AMPLIFY and AMPLIFY-EXT studies The primary objective of AMPLIFY was to determine whether apixaban was noninferior to enoxaparin/warfarin for the incidence of recurrent VTE (venous thromboembolism) or VTE-related death Patients with an objectively confirmed symptomatic DVT and/or PE were randomized to treatment with apixaban 10 mg twice daily orally for 7 days followed by apixaban 5 mg twice daily orally for 6 months

The duration of treatment with Eliquis (apixaban) for Pulmonary Embolism (PE) is at least 6 months 2.

From the Research

Duration of Treatment with Eliquis (Apixaban) for Pulmonary Embolism (PE)

• The optimal duration of anticoagulation after a first episode of PE remains controversial and should be made on an individual basis, balancing the estimated risk for recurrence without anticoagulant treatment against bleeding risk under anticoagulation 3.
• Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE 4.
• Anticoagulant therapy should be discontinued after the initial 3 to 6 months in those patients who had the first episode in association with temporary risk factors 3.
• After 3 to 6 months of anticoagulant treatment, patients with a first unprovoked event and an estimated low risk for bleeding complications should be evaluated for indefinite treatment on an individualized basis 3.
• Extended anticoagulation with apixaban with either a treatment dose (5 mg twice daily) or thromboprophylactic dose (2.5 mg twice daily) reduces the risk of recurrent venous thromboembolism without increase in the rate of major bleeding 5.

Factors Influencing Treatment Duration

• The decision to extend anticoagulation should be based on the individual patient's risk factors, including the presence of temporary or permanent risk factors for VTE 3, 4.
• The safety profile of direct oral anticoagulants, such as apixaban, may allow for extension of anticoagulation in a larger proportion of patients after an unprovoked PE 3.
• The presence of comorbidities, such as cardiac disease, and the use of antiplatelet agents may influence the decision to extend anticoagulation 6.