From the Guidelines
For a patient with a right lower extremity deep vein thrombosis (DVT) that occurred 3 months after an ankle fracture, the recommended duration of Eliquis (apixaban) therapy is typically 3 months. The standard dosing regimen for Eliquis in this situation is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of the treatment period, as recommended by the Chest guideline and expert panel report 1, 2. This provoked DVT, triggered by the ankle fracture and likely immobilization, has a lower risk of recurrence than unprovoked DVT, which is why a 3-month course is generally sufficient.
Some key points to consider in the management of this patient include:
- The patient should be monitored for signs of bleeding, which is the main side effect of anticoagulation therapy 2.
- After completing the prescribed course, the patient should follow up with their healthcare provider to assess whether extended therapy is needed based on their specific circumstances and risk profile 1.
- Individual risk factors such as previous clotting history, family history of clots, or the presence of ongoing risk factors should be taken into account when determining the exact duration of therapy.
- The use of apixaban is recommended over vitamin K antagonist (VKA) as treatment-phase anticoagulant therapy due to its favorable benefit-to-harm ratio 2.
It's essential to note that while the evidence from the 2016 Chest guideline and expert panel report 3 provides valuable insights into the management of cancer-associated thrombosis, it may not be directly applicable to this patient's situation, as there is no mention of active cancer. Therefore, the more recent and relevant guidelines from 1 and 2 should be prioritized in making treatment decisions. The 3-month treatment phase of anticoagulation is a strong recommendation with moderate-certainty evidence, and it is crucial to adhere to this guideline to minimize the risk of recurrence and bleeding complications.
From the FDA Drug Label
1.3 Treatment of Deep Vein Thrombosis Apixaban tablets are indicated for the treatment of DVT.
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.
1.5 Reduction in the Risk of Recurrence of DVT and PE Apixaban tablets are indicated to reduce the risk of recurrent DVT and PE following initial therapy.
2.1 Recommended Dose ... 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 recommended duration of Eliquis (apixaban) therapy for a patient with a deep vein thrombosis (DVT) is at least 6 months, after which the dose can be reduced to 2.5 mg twice daily for the reduction in the risk of recurrence of DVT and PE 4.