Recommended Dose of Apixaban (Eliquis) for DVT Treatment
For the treatment of deep vein thrombosis (DVT), apixaban should be administered at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. 1
Dosing Schedule
- Initial treatment phase: 10 mg orally twice daily for 7 days 1, 2
- Maintenance phase: 5 mg orally twice daily for at least 3 months (typically 6 months) 1, 2
- Extended treatment phase (to reduce risk of recurrence): 2.5 mg twice daily after completing at least 6 months of treatment 1
Evidence Supporting This Regimen
- The AMPLIFY trial demonstrated that apixaban (10 mg twice daily for 7 days followed by 5 mg twice daily for 6 months) was non-inferior to conventional therapy (enoxaparin/warfarin) in preventing recurrent VTE or VTE-related death (2.3% vs 2.7%) 2
- The incidence of major bleeding was significantly lower with apixaban compared to conventional therapy (0.6% vs 1.8%) 2
- This dosing regimen has been shown to effectively reduce coagulation activity in patients with acute DVT 3
Special Considerations
Renal Function
- Apixaban should be avoided in patients with severe renal impairment (CrCl <15 mL/min) 2, 1
- Patients with CrCl <25 mL/min were excluded from clinical trials 2
Hepatic Function
- Avoid in patients with hepatic impairment (transaminases >2 times upper limit of normal or total bilirubin >1.5 times upper limit of normal) 2, 1
Temporary Interruption for Procedures
- Discontinue apixaban at least 48 hours prior to elective surgery with moderate/high bleeding risk 1
- Discontinue at least 24 hours prior to procedures with low bleeding risk 1
- Resume after adequate hemostasis has been established 1
Important Warnings
- Premature discontinuation increases risk of thrombotic events 1
- Risk of spinal/epidural hematoma in patients receiving neuraxial anesthesia or undergoing spinal puncture 1
- Do not double the dose to make up for a missed dose 1
Conversion Between Anticoagulants
- When switching from warfarin to apixaban: Start apixaban when INR is below 2.0 1
- When switching from apixaban to warfarin: Consider bridging with parenteral anticoagulant 1
- When switching between apixaban and other anticoagulants: Begin the new agent at the time the next dose of the previous agent would have been taken 1
Monitoring
- Routine laboratory monitoring is not required 2
- The fixed-dose regimen provides predictable anticoagulation without the need for regular blood tests 4
Pitfalls to Avoid
- Failing to use the higher initial dose (10 mg twice daily) for the first 7 days may reduce efficacy 5
- Conversely, continuing the higher dose beyond 7 days may increase bleeding risk 5
- Patients receiving P-glycoprotein inhibitors or with increased age and creatinine may have higher bleeding risk and require careful monitoring 5