Apixaban Dosing for DVT Treatment
For acute DVT treatment, start apixaban at 10 mg orally twice daily for 7 days, then reduce to 5 mg twice daily for at least 3 months, with no need for initial parenteral anticoagulation. 1, 2, 3
Initial Treatment Phase (Days 1-7)
- Begin with 10 mg orally twice daily for the first 7 days to achieve rapid anticoagulation 1, 2, 3
- No bridging with heparin or other parenteral anticoagulation is required before starting apixaban, which simplifies treatment compared to warfarin 1, 2, 4
- This loading dose regimen was validated in the AMPLIFY trial, demonstrating non-inferiority to conventional enoxaparin/warfarin therapy with significantly lower major bleeding rates (0.6% vs 1.8%) 1
Maintenance Phase (After Day 7)
- Transition to 5 mg orally twice daily after completing the initial 7-day loading phase 1, 2, 3
- Continue this dose for a minimum of 3 months for provoked DVT (DVT with a clear reversible trigger like surgery or trauma) 1, 2
- For unprovoked DVT or patients with ongoing risk factors, treatment duration beyond 3 months should be considered 1, 2
Extended Treatment Phase (Beyond 6 Months)
- For patients requiring long-term anticoagulation beyond 6 months, reduce to 2.5 mg orally twice daily for secondary prevention 1, 2, 3
- This reduced dose minimizes bleeding risk while maintaining efficacy for preventing recurrent DVT 1, 2
- Recent evidence shows that this low-intensity regimen (2.5 mg twice daily) significantly reduces recurrent VTE risk compared to placebo (1.3% vs 10.0%, P<0.001) with minimal major bleeding 5
Critical Dose Adjustments and Contraindications
- Avoid apixaban in severe renal impairment (CrCl <15 mL/min) and use caution with CrCl <25 mL/min 1
- Avoid in significant hepatic impairment (transaminases >2x upper limit of normal or total bilirubin >1.5x upper limit of normal) 1
- Reduce dose by 50% when coadministered with combined P-gp and strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) for patients on 5 mg or 10 mg twice daily 3
- In patients already taking 2.5 mg twice daily, avoid coadministration with these strong inhibitors 3
Special Populations
Cancer-Associated DVT
- Apixaban has shown non-inferiority to dalteparin for cancer-associated VTE and represents a viable oral option 1, 2
- Use the same dosing regimen as for non-cancer DVT (10 mg twice daily for 7 days, then 5 mg twice daily) 1
Key Advantages Over Traditional Therapy
- Fixed-dose regimen eliminates the need for routine laboratory monitoring (no INR checks required) 2, 4
- Rapid onset of action allows immediate therapeutic anticoagulation without heparin bridging 1, 4
- Lower bleeding risk compared to conventional warfarin-based therapy 1, 4
Critical Safety Warnings
- Premature discontinuation increases thrombotic event risk—if stopping apixaban for reasons other than bleeding or treatment completion, provide coverage with another anticoagulant 3
- Epidural or spinal hematomas may occur with neuraxial anesthesia—discontinue at least 48 hours before procedures with moderate-to-high bleeding risk 3
- Monitor patients frequently for neurological impairment if undergoing spinal procedures 3