Duration of Apixaban Treatment for Deep Vein Thrombosis (DVT)
The recommended duration of apixaban treatment for DVT depends primarily on whether the thrombosis was provoked by a transient risk factor or is unprovoked, with 3 months being appropriate for provoked DVT and extended therapy (no scheduled stop date) often recommended for unprovoked DVT. 1
Treatment Duration Based on DVT Classification
Provoked DVT
- For DVT provoked by surgery (a transient risk factor), treatment with apixaban for 3 months is recommended over shorter or longer periods 1
- For DVT provoked by a non-surgical transient risk factor (e.g., trauma, pregnancy), 3 months of anticoagulation is recommended 1
- In patients with isolated distal DVT provoked by surgery or a non-surgical transient risk factor, 3 months of treatment is recommended 1
Unprovoked DVT
- For unprovoked DVT (proximal or isolated distal), treatment with anticoagulation for at least 3 months is recommended 1
- After the initial 3 months, patients with unprovoked DVT should be evaluated for extended therapy (no scheduled stop date) based on bleeding risk 1
- For patients with a first unprovoked proximal DVT and low or moderate bleeding risk, extended anticoagulant therapy is suggested 1
- For patients with high bleeding risk, 3 months of therapy is recommended over extended therapy 1
Cancer-Associated DVT
- For patients with DVT and active cancer without high bleeding risk, extended anticoagulant therapy (no scheduled stop date) is recommended 1
- For cancer patients with high bleeding risk, extended anticoagulant therapy is still suggested over 3 months of therapy 1
Apixaban Dosing Regimen
- Initial treatment: 10 mg orally twice daily for the first 7 days 1
- Maintenance treatment: 5 mg orally twice daily 1
- For extended therapy (beyond 6 months): A reduced dose of 2.5 mg twice daily can be considered 1
Special Considerations
- In all patients receiving extended anticoagulant therapy, the continuing use of treatment should be reassessed at periodic intervals (e.g., annually) 1
- Apixaban and rivaroxaban offer the advantage of reduced-intensity dosing for patients on indefinite anticoagulation whose VTE occurred ≥6 months ago 1
- Recent evidence suggests that low-intensity therapy with apixaban (2.5 mg twice daily) for extended treatment results in a lower risk of recurrent VTE than placebo, with a low risk of major bleeding 2
- For patients with DVT who require percutaneous coronary intervention (PCI), it is critical to reassess the recommended duration of anticoagulant therapy 1
Cautions and Contraindications
- Apixaban should be avoided in patients with severe renal impairment (creatinine clearance <15 mL/min) 1
- Apixaban should be avoided in patients with significant hepatic impairment 1
- The risk-benefit ratio of extended therapy should be carefully evaluated in patients with high bleeding risk 1
By following these evidence-based recommendations for the duration of apixaban treatment in DVT, clinicians can optimize outcomes while minimizing bleeding risks for their patients.