From the Guidelines
The decision to reduce Eliquis (apixaban) dose after DVT treatment typically occurs after completing the initial treatment phase of 6 months at the full dose of 5 mg twice daily, and for extended treatment beyond 6 months, a reduced dose of 2.5 mg twice daily may be considered for secondary prevention of recurrent DVT or PE, as recommended by the 2019 ESC guidelines 1. When considering dose reduction, several factors influence this decision, including:
- The original clot's cause (provoked vs. unprovoked)
- Personal bleeding risk
- Kidney function
- Age
- Weight
- Whether the DVT was the first clotting event or a recurrence The dose reduction aims to balance continued protection against new clots while minimizing bleeding risks associated with long-term anticoagulation. Some patients with high recurrence risk may need to remain on the full dose indefinitely, as suggested by the Chest guidelines 1. Regular follow-up appointments are essential during this transition to monitor for any signs of new clots or bleeding complications. It is also important to note that the patient’s bleeding risk should be assessed to identify and treat modifiable bleeding risk factors, which may influence decision-making on the duration and regimen/dose of anticoagulant treatment, as recommended by the European Heart Journal 1. In addition, the AMPLIFY-EXTEND Investigators found that both apixaban doses (2.5 mg and 5 mg twice daily) reduced recurrent VTE without increasing major bleeding, providing further evidence for the consideration of dose reduction 1.
From the FDA Drug Label
- DOSAGE & ADMINISTRATION 2.1 Recommended Dose ... Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily. ... Reduction in the Risk of Recurrence of DVT and PE The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE
The dose of Eliquis (apixaban) should be reduced from 10 mg twice daily to 5 mg twice daily after the first 7 days of therapy for Deep Vein Thrombosis (DVT) management. Further reduction to 2.5 mg twice daily can be considered after at least 6 months of treatment for reduction in the risk of recurrence of DVT 2.
From the Research
Reducing Eliquis (Apixaban) Dose After DVT Management
- The decision to reduce the dose of Eliquis (apixaban) after Deep Vein Thrombosis (DVT) management is based on various factors, including the patient's risk of recurrence and bleeding 3.
- According to a study, patients with permanent thrombotic risk factors or without recanalization of the UEDVT can be shifted to low-dose DOACs (apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily) after the acute phase of thrombosis 4.
- The study found that during therapy with full-dose DOACs, 1 patient presented recurrence of thrombosis, and no thromboembolic events were observed during treatment with low-dose DOACs 4.
- Another study found that prescribing patterns of OFXAi lead-in therapy duration are variable in patients receiving initial parenteral anticoagulation, and larger cohorts are needed to better define the safety and efficacy of lead-in reduction 5.
- The American Society of Hematology recommends that the duration of anticoagulation therapy for VTE should be based on the estimated risks of VTE recurrence and treatment-induced bleeding 3.
- The risk of VTE recurrence is higher in idiopathic events, male subjects, patients with persistently elevated D-dimer level, and during the first two years after discontinuation of treatment 3.
- New therapeutic aspects, such as the possibility of pursuing anticoagulant treatment at a reduced INR after an initial period with an INR 2-3, and the advent of new, more specific and orally active anticoagulants, may impact on the duration of anticoagulant therapy after a venous thromboembolic event 3.
Factors Influencing Dose Reduction
- Patient's risk of recurrence and bleeding 3
- Presence of permanent thrombotic risk factors or without recanalization of the UEDVT 4
- Age and comorbidities, such as cardiac comorbidities and antiplatelet use 5
- Duration of initial parenteral anticoagulation 5