What is the recommended dose and frequency of Eliquis (apixaban) for a new Deep Vein Thrombosis (DVT)?

Apixaban Dosing for New DVT Treatment

For a new Deep Vein Thrombosis (DVT), apixaban (Eliquis) 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. 1, 2, 3

Initial Treatment Phase

• Apixaban 10 mg orally twice daily for the first 7 days 1, 2, 3
• No parenteral anticoagulant (such as heparin) is required before starting apixaban, unlike some other DOACs 1
• The medication should be taken approximately 12 hours apart 3

Maintenance Phase

• After completing the 7-day initial treatment, transition to 5 mg orally twice daily 1, 2, 3
• This maintenance dose should be continued for at least 3 months 2
• If a dose is missed, it should be taken as soon as possible on the same day and twice-daily administration should be resumed (do not double the dose) 3

Duration of Therapy

• Standard treatment duration is at least 3 months 2
• After 6 months of initial therapy, either continuing 5 mg twice daily or reducing to 2.5 mg twice daily can be considered for secondary prevention of recurrent DVT 1
• For patients requiring indefinite anticoagulation, the risks and benefits should be reassessed at least annually 1

Dose Adjustments

• For patients taking medications that are combined P-glycoprotein (P-gp) and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir), reduce the dose by 50% 3
• If already on the reduced dose of 2.5 mg twice daily, avoid coadministration with combined P-gp and strong CYP3A4 inhibitors 3
• No dose adjustment is required for moderate renal impairment, though caution is advised in severe renal impairment (CrCl <15 mL/min) 2, 4

Clinical Evidence Supporting This Regimen

• The AMPLIFY trial demonstrated that apixaban (10 mg twice daily for 7 days followed by 5 mg twice daily) was non-inferior to conventional therapy in preventing recurrent VTE or VTE-related death 2, 5
• This regimen was associated with a significantly lower incidence of major bleeding compared to conventional therapy (0.6% vs 1.8%) 2, 5
• The AMPLIFY-J study in Japanese patients confirmed similar safety and efficacy profiles 5

Monitoring

• Routine laboratory monitoring is not required for apixaban, as the fixed-dose regimen provides predictable anticoagulation 2
• If temporary interruption is needed for surgery or invasive procedures, apixaban should be discontinued at least 48 hours prior to procedures with moderate/high bleeding risk, and at least 24 hours prior to procedures with low bleeding risk 3

Common Pitfalls to Avoid

• Do not confuse DVT treatment dosing with DVT prophylaxis dosing (which is 2.5 mg twice daily) 3, 6
• Do not confuse with atrial fibrillation dosing (which is 5 mg twice daily, or 2.5 mg twice daily in certain populations) 3
• Avoid missing the critical 7-day initial higher-dose treatment phase, which is essential for effective initial thrombus management 1, 2