Apixaban Dosing Regimen for DVT Treatment
For patients with DVT, the appropriate regimen for initiating Eliquis (apixaban) is 10 mg taken orally twice daily for the first 7 days, followed by 5 mg taken orally twice daily for at least 3 months. 1, 2
Initial Treatment Phase
- Apixaban should be started at 10 mg orally twice daily for the first 7 days of therapy 1, 2
- Unlike some other DOACs (direct oral anticoagulants), apixaban does not require initial parenteral anticoagulation 1, 3
- This loading dose regimen ensures rapid anticoagulation effect for acute management of DVT 2
Maintenance Phase
- After the initial 7 days, transition to 5 mg orally twice daily 1, 2
- Continue this maintenance dose for at least 3 months for provoked DVT 1
- For unprovoked DVT or patients with ongoing risk factors, longer treatment duration should be considered 1, 3
Extended Treatment Phase
- For patients requiring extended anticoagulation beyond 6 months, the dose can be reduced to 2.5 mg twice daily for secondary prevention 3, 1
- This dose reduction helps minimize bleeding risk while maintaining efficacy for preventing recurrent DVT 3, 1
Special Considerations
- For patients taking combined P-glycoprotein (P-gp) and strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, ritonavir), reduce the dose by 50% 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) 2
- For patients undergoing elective surgery, 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 2
Advantages of Apixaban for DVT Treatment
- Apixaban has demonstrated similar efficacy to conventional treatment (LMWH/VKA) with reduced risk of major bleeding 3, 4
- Fixed-dose regimen eliminates the need for routine laboratory monitoring 1, 4
- Simple oral administration improves treatment adherence compared to injectable anticoagulants 4
Cancer-Associated DVT
- In patients with DVT and cancer, LMWH is traditionally preferred over DOACs, but recent evidence supports apixaban as a viable option 3, 5
- Apixaban has been shown to be noninferior to dalteparin for cancer-associated VTE without increased risk of major bleeding 5
This dosing regimen provides effective anticoagulation while minimizing bleeding risk, making apixaban a convenient option for DVT treatment with its fixed-dose oral administration and no requirement for routine laboratory monitoring.