Is Eliquis (apixaban) the best choice for a new Deep Vein Thrombosis (DVT)?

Apixaban (Eliquis) is the Best Choice for New DVT Treatment

For patients with a new deep vein thrombosis (DVT), apixaban is recommended over vitamin K antagonists (VKAs) as the first-line treatment option due to its superior safety profile with similar efficacy. 1

Direct Oral Anticoagulant (DOAC) Superiority for DVT Treatment

• The 2021 CHEST guidelines strongly recommend apixaban, dabigatran, edoxaban, or rivaroxaban over vitamin K antagonists for the initial 3-month treatment phase of venous thromboembolism (VTE), including DVT 1
• Among DOACs, apixaban has demonstrated a favorable safety profile with fewer bleeding events compared to standard anticoagulation while maintaining similar efficacy in preventing recurrent VTE 1
• The FDA has approved apixaban specifically for the treatment of DVT and reduction in the risk of recurrent DVT following initial therapy 2

Apixaban Dosing Regimen for New DVT

• For new DVT treatment, apixaban should be administered at 10 mg orally twice daily for the first 7 days, followed by 5 mg orally twice daily for at least 3 months 2
• After completing the initial 3-month treatment phase, patients should be assessed for extended-phase therapy based on risk factors for recurrence 3
• For extended therapy beyond 6 months, a reduced dose of 2.5 mg twice daily can be considered 3

Special Populations and Considerations

• In patients with cancer-associated thrombosis, oral factor Xa inhibitors (including apixaban) are now recommended over low molecular weight heparin (LMWH) 1
• Among factor Xa inhibitors, apixaban may be preferred in patients with luminal gastrointestinal malignancies due to lower risk of GI bleeding compared to edoxaban and rivaroxaban 1
• For patients with confirmed antiphospholipid syndrome, adjusted-dose VKA therapy is suggested over DOACs 1
• Apixaban should be avoided in patients with severe renal impairment (creatinine clearance <15 mL/min) or significant hepatic impairment 3

Duration of Treatment

• For DVT provoked by surgery or a non-surgical transient risk factor, 3 months of treatment is recommended 3
• For unprovoked DVT, at least 3 months of treatment followed by evaluation for extended therapy based on bleeding risk is recommended 3
• Extended anticoagulation should not be offered to patients with DVT diagnosed in the setting of a major transient risk factor 1

Practical Considerations

• Apixaban does not require routine laboratory monitoring, unlike VKAs 4
• Apixaban should be temporarily discontinued at least 48 hours prior to elective surgery or invasive procedures with moderate to high bleeding risk 2
• If anticoagulation with apixaban is discontinued for reasons other than bleeding or completion of therapy, consider coverage with another anticoagulant to reduce thrombotic risk 2
• Patients should be advised not to miss doses, as this increases the risk of thrombotic events 2

Potential Advantages of Apixaban Over Other DOACs

• In clinical studies, apixaban has demonstrated a favorable bleeding profile compared to other anticoagulants 5
• Apixaban's twice-daily dosing may provide more consistent anticoagulation compared to once-daily agents 4
• Japanese studies have shown apixaban to be well-tolerated with a favorable safety profile compared to UFH/warfarin 5

While all DOACs are recommended over VKAs for DVT treatment, apixaban offers an excellent combination of efficacy and safety that makes it an optimal choice for most patients with new DVT.