What is the recommended dosing for Eliquis (apixaban) in a patient with Deep Vein Thrombosis (DVT) after a heparin drip?

Apixaban Dosing for DVT After Heparin Drip

For patients transitioning from a heparin drip to apixaban for DVT treatment, the recommended dosing is 10 mg orally twice daily for the first 7 days followed by 5 mg orally twice daily. 1

Initial Treatment Phase

• Apixaban should be started when the heparin infusion is discontinued, with no need for overlap between the two medications 2
• The loading dose regimen is 10 mg orally twice daily for the first 7 days 1
• After the initial 7-day period, transition to the maintenance dose of 5 mg orally twice daily 1
• No bridging with low molecular weight heparin is required when transitioning from heparin to apixaban 2

Maintenance Phase and Duration

• Continue apixaban 5 mg twice daily for at least 3 months for provoked DVT 1
• For unprovoked DVT or patients with ongoing risk factors, longer treatment duration is typically recommended 1
• After 6 months of initial therapy, dose reduction to 2.5 mg twice daily can be considered for extended secondary prevention 1

Special Considerations

• Renal Function: Dose adjustment is not required for mild to moderate renal impairment, but apixaban should be avoided in patients with severe renal impairment (CrCl <15 mL/min) 2
• Hepatic Function: Avoid in patients with severe hepatic impairment or coagulopathy 2
• Drug Interactions: Reduce apixaban dose by 50% when co-administered with strong dual inhibitors of CYP3A4 and P-glycoprotein 2
• Weight/Age: No specific dose adjustments for DVT treatment based on weight or age alone, unlike dosing for atrial fibrillation 2

Temporary Interruption for Procedures

• Discontinue apixaban at least 48 hours prior to elective surgery or invasive procedures with moderate to high bleeding risk 2
• Discontinue at least 24 hours prior to procedures with low bleeding risk 2
• Resume apixaban as soon as adequate hemostasis has been established 2

Advantages of Apixaban Over Other Anticoagulants

• No need for routine laboratory monitoring 3
• Fixed dosing regimen simplifies treatment 3
• Lower risk of major bleeding compared to traditional vitamin K antagonist therapy 1
• Can be administered without initial parenteral anticoagulation (unlike dabigatran and edoxaban) 1

Common Pitfalls to Avoid

• Do not double the dose if a dose is missed; take the missed dose as soon as possible on the same day and resume the normal twice-daily schedule 2
• Do not confuse DVT treatment dosing with the lower doses used for DVT prophylaxis (2.5 mg twice daily) 2
• Ensure adequate patient education regarding the importance of strict adherence to the dosing schedule 3
• Be aware that apixaban affects INR measurements, making them unreliable for monitoring during transition to warfarin if needed 2

Remember that this dosing regimen is specific for DVT treatment and differs from apixaban dosing for atrial fibrillation or prophylactic indications 2.