Duration of Apixaban for Provoked DVT
For provoked DVT, treat with apixaban for exactly 3 months, then stop—extended therapy beyond this period is not recommended. 1
Treatment Algorithm Based on Provoking Factor
Surgery-Provoked DVT
- Treat for 3 months only (Grade 1B recommendation) 1
- Do NOT extend beyond 3 months—annual recurrence risk after stopping is <1% 1, 2
- Do NOT use time-limited periods of 6,12, or 24 months 1
- Do NOT use indefinite therapy (no scheduled stop date) 1
Non-Surgical Transient Risk Factor-Provoked DVT
- Treat for 3 months as the standard duration 1
- For patients with low or moderate bleeding risk: 3 months is suggested over extended therapy (Grade 2B) 1
- For patients with high bleeding risk: 3 months is strongly recommended over extended therapy (Grade 1B) 1
Apixaban Dosing for DVT Treatment
Initial 7 days: 10 mg orally twice daily 3
Days 8 through 90: 5 mg orally twice daily 3
After day 90: Stop therapy for provoked DVT 1
Critical Distinction: Provoked vs. Unprovoked
The evidence strongly differentiates treatment duration based on whether the DVT was provoked or unprovoked. This distinction is the single most important factor in determining anticoagulation duration 1, 2:
- Provoked DVT (surgery, trauma, immobility, estrogen therapy): 3 months only 1
- Unprovoked DVT: Consider extended therapy due to >5% annual recurrence risk 1, 2, 4
Important Caveats and Pitfalls
Avoid These Common Errors:
Do not confuse distal with proximal DVT location when determining duration—both provoked proximal and provoked distal DVT receive 3 months of therapy 1, 2
Do not extend therapy for obesity alone—obesity is not considered a persistent risk factor that justifies extended anticoagulation in provoked DVT 2
Do not continue hormonal therapy during anticoagulation—women with hormone-associated DVT should discontinue hormonal therapy before stopping anticoagulation at 3 months 2
Emerging Evidence on Enduring Risk Factors
Recent high-quality evidence from 2025 suggests a nuanced exception: patients with provoked DVT who have enduring risk factors (obesity, heart failure, inflammatory bowel disease) may benefit from extended low-intensity apixaban (2.5 mg twice daily) 5. In the HI-PRO trial, this approach reduced recurrent VTE from 10.0% to 1.3% (HR 0.13,95% CI 0.04-0.36, P<0.001) with minimal bleeding risk 5. However, this represents evolving practice and is not yet incorporated into major guidelines 1.
Bleeding Risk Assessment
High bleeding risk features that favor stopping at 3 months include 1, 2:
- Age ≥80 years
- Previous major bleeding
- Recurrent falls
- Need for dual antiplatelet therapy
- Severe renal or hepatic impairment
Drug Interactions Requiring Dose Adjustment
If patient is on combined P-gp and strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir): reduce apixaban dose by 50% during the treatment period 3