Apixaban for Deep Vein Thrombosis (DVT) Treatment
Apixaban (Eliquis) is strongly recommended for the treatment of deep vein thrombosis (DVT) as it is non-inferior to conventional therapy while offering a significantly lower risk of major bleeding. 1, 2
FDA-Approved Indications
- Apixaban is FDA-approved for the treatment of DVT 2
- Apixaban is also indicated for the treatment of pulmonary embolism (PE) 2
- Additionally approved for reducing the risk of recurrent DVT and PE following initial therapy 2
Dosing Regimen
- For DVT treatment, the recommended dosing is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily 2
- For extended treatment to reduce risk of recurrence, the recommended dose is 2.5 mg twice daily after at least 6 months of initial treatment 2
Evidence Supporting Use in DVT
- The American College of Chest Physicians (ACCP) suggests apixaban over vitamin K antagonists (VKA) for DVT treatment in patients without cancer (Grade 2B recommendation) 1
- Apixaban has been shown to be non-inferior to conventional therapy (enoxaparin/warfarin) for preventing recurrent VTE or VTE-related death 3, 4
- Major bleeding occurs significantly less frequently with apixaban compared to conventional therapy (relative risk 0.31; 95% CI 0.17–0.55; P < 0.001) 1, 4
Special Populations
- For cancer patients with DVT, low-molecular-weight heparin (LMWH) is suggested over apixaban (Grade 2C) 1, 5
- However, more recent evidence suggests apixaban may be non-inferior to LMWH for cancer-associated VTE without increased bleeding risk 4
- For patients with recurrent VTE while on apixaban, switching to LMWH is suggested 3
Duration of Treatment
- Minimum treatment duration is 3 months for most DVT patients 1
- For unprovoked proximal DVT, extended anticoagulation therapy is suggested over limiting treatment to 3 months, especially in patients with low or moderate bleeding risk 3
- For DVT provoked by surgery, treatment for 3 months is recommended over shorter or longer periods 1
Monitoring and Follow-up
- No routine laboratory monitoring of anticoagulant effect is required for apixaban, unlike warfarin 3
- Regular evaluation should be performed to assess drug tolerance, adherence, hepatic and renal function, and bleeding risk 3
Contraindications and Cautions
- Apixaban should be avoided in patients with severe hepatic impairment 5
- Use with caution in patients with renal dysfunction, as 27% of the drug is eliminated through renal clearance 5
- Contraindicated in patients with severe renal impairment (CrCl <15 mL/min) 5
- Discontinue at least 48 hours prior to elective surgery or invasive procedures with moderate/high bleeding risk 2
Clinical Advantages
- Fixed-dose regimen eliminates need for routine laboratory monitoring 6, 7
- Rapid onset of action and predictable pharmacokinetics 7
- Lower risk of major bleeding compared to conventional therapy 8
- Real-world studies show 27-39% lower risk of major bleeding and 25-39% lower risk of recurrent VTE compared to warfarin 8