What is the recommended approach for a patient on Eliquis (apixaban) for 3 months following a Deep Vein Thrombosis (DVT)?

Approach to Repeating Ultrasound for DVT After 3 Months of Eliquis

Routine repeat ultrasound imaging is not recommended after completing 3 months of anticoagulation for DVT—the critical decision is whether to continue or stop anticoagulation based on DVT provocation status and bleeding risk, not imaging findings. 1

Key Decision Point: Determine DVT Provocation Status

The decision to continue or discontinue Eliquis after 3 months depends entirely on whether the DVT was provoked or unprovoked:

Provoked DVT (Stop Anticoagulation)

If the DVT was provoked by a major transient risk factor (surgery), discontinue anticoagulation after 3 months. 1 This carries a strong recommendation with moderate-certainty evidence, as recurrence risk is less than 1% annually. 2

• For surgery-provoked DVT: Stop anticoagulation at 3 months—do not extend therapy beyond this timeframe. 1
• For minor transient risk factors (immobilization, trauma, pregnancy): Stop anticoagulation at 3 months, though this is a weaker recommendation. 1
• For hormone-associated DVT: Stop anticoagulation at 3-6 months if hormonal therapy is discontinued, with approximately 50% lower recurrence risk than unprovoked DVT. 1, 2

Unprovoked DVT (Consider Extended Anticoagulation)

If the DVT was unprovoked (no identifiable trigger), offer extended anticoagulation with Eliquis at the standard 5 mg twice daily dose—do not stop at 3 months. 1 This carries a strong recommendation with moderate-certainty evidence.

• After completing 3 months: Reassess the risk-benefit ratio for extended therapy. 1
• Low or moderate bleeding risk: Extended anticoagulation is suggested (Grade 2B). 1
• High bleeding risk: Stop anticoagulation at 3 months (Grade 1B). 1
• Second unprovoked DVT with low bleeding risk: Extended anticoagulation is strongly recommended (Grade 1B). 1

Role of Repeat Ultrasound Imaging

Repeat ultrasound at 3 months does not guide the decision to continue or stop anticoagulation. The presence or absence of residual thrombus on imaging should not determine treatment duration. 3, 4

• The decision is based on provocation status and bleeding risk, not imaging findings. 1, 2
• Residual thrombosis has been studied as a predictor but is not incorporated into current guideline recommendations. 4

Extended Therapy Dosing

For patients continuing beyond 6 months of treatment for unprovoked DVT, reduce Eliquis to 2.5 mg twice daily. 5 This lower-intensity regimen is specifically indicated for reduction in risk of recurrent DVT after at least 6 months of standard treatment. 5

Bleeding Risk Assessment

Evaluate bleeding risk using these specific factors:

• Low bleeding risk: Age <70 years, no prior bleeding, no concomitant antiplatelet therapy, good INR control during initial treatment. 1
• High bleeding risk: Advanced age, previous bleeding episodes, concomitant antiplatelet drugs (aspirin, clopidogrel), renal/hepatic impairment. 1

Ongoing Monitoring

For patients on extended anticoagulation, reassess the decision to continue therapy at least annually. 1 This should occur at times of significant health status changes and should evaluate:

• Ongoing bleeding risk
• Patient preference
• Any new provoking factors or comorbidities 1

Special Populations

Cancer-associated DVT: Extended anticoagulation is recommended regardless of bleeding risk, with treatment continuing at least until resolution of active malignancy. 1, 2, 4