From the Research
There is no specific hemoglobin (Hgb) threshold that absolutely prohibits starting Eliquis (apixaban) for deep vein thrombosis (DVT), but caution is advised when Hgb is below 8 g/dL due to increased bleeding risk, as supported by the most recent study 1. The decision to start Eliquis in a patient with low hemoglobin should be individualized based on the balance between thrombosis risk and bleeding risk. For patients with active bleeding or severe anemia (Hgb < 7 g/dL), it may be prudent to address the anemia first or consider alternative approaches such as an inferior vena cava filter if anticoagulation must be delayed. When initiating Eliquis in patients with borderline hemoglobin levels, closer monitoring is recommended with regular complete blood count checks. The standard Eliquis dosing for DVT treatment is 10 mg twice daily for 7 days followed by 5 mg twice daily. Key considerations include:
- The risk of recurrent VTE and major bleeding in patients with cancer-associated VTE, as evaluated in the study 1
- The effectiveness and safety of extended treatment with apixaban versus low-molecular-weight heparin in this patient population, with apixaban showing lower rates of recurrent VTE, major bleeding, and clinically relevant nonmajor bleeding 1
- The importance of individualized decision-making and close monitoring in patients with low hemoglobin levels, as anticoagulation increases bleeding risk in patients with significant anemia. Overall, the most recent and highest quality study 1 supports the use of apixaban in patients with DVT, while emphasizing the need for careful consideration of bleeding risk, particularly in those with low hemoglobin levels.