From the Guidelines
Eliquis (apixaban) is a recommended option for DVT prophylaxis after hip surgery, with a typical regimen of 2.5 mg taken orally twice daily, starting 12-24 hours after surgery and continuing for 35 days. This is based on the results of the ADVANCE-3 trial, which demonstrated the superiority of apixaban over enoxaparin in preventing total VTE or all-cause mortality in patients undergoing hip arthroplasty 1. The study found that apixaban was associated with a lower risk of VTE (1.4% vs 3.9%) and a similar risk of major or clinically relevant nonmajor bleeding compared to enoxaparin.
Key points to consider when using Eliquis for DVT prophylaxis after hip surgery include:
- Starting the medication 12-24 hours after surgery and continuing for 35 days
- Taking the medication at approximately the same times each day with or without food
- Informing all healthcare providers about taking Eliquis before any procedures, as it may need to be temporarily discontinued to reduce bleeding risk
- Monitoring for common side effects such as bruising and minor bleeding, and seeking immediate medical attention for signs of serious bleeding
The use of Eliquis for DVT prophylaxis after hip surgery is supported by the American College of Chest Physicians evidence-based clinical practice guidelines, which recommend the use of apixaban as an option for thromboprophylaxis in patients undergoing elective hip or knee replacement surgery 1. Overall, Eliquis is a effective and safe option for DVT prophylaxis after hip surgery, with a favorable risk-benefit profile compared to other anticoagulants.
From the FDA Drug Label
1.2 Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery Apixaban tablets are indicated for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery.
2.1 Recommended Dose Prophylaxis of Deep Vein Thrombosis Following Hip or Knee Replacement Surgery The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery.
In patients undergoing hip replacement surgery, the recommended duration of treatment is 35 days.
Yes, apixaban (Eliquis) can be used after hip surgery for DVT prophylaxis. The recommended dose is 2.5 mg taken orally twice daily, starting 12 to 24 hours after surgery, for a duration of 35 days 2.
From the Research
Eligibility of Eliquis for DVT Prophylaxis After Hip Surgery
- Eliquis (apixaban) is indicated for the prevention of venous thromboembolism (VTE) in adults who have had knee or hip replacement surgery 3.
- The standard anticoagulant for prevention of VTE in patients undergoing hip or knee replacement surgery is a low-molecular-weight heparin (LMWH) such as subcutaneous enoxaparin, but apixaban is an emerging option 4.
Efficacy and Safety of Apixaban
- Apixaban has been shown to be generally effective and well-tolerated for thromboprophylaxis after major orthopedic surgery, with a lower risk of VTE events and overall mortality combined compared to LMWH 5.
- However, the incidence of bleeding did not differ between the apixaban and enoxaparin groups in some studies 4, while other studies found apixaban to have a lower risk of clinically relevant bleeding compared to enoxaparin 6.
- Apixaban seems equally effective and safe to LMWH twice a day, but may be a superior thromboprophylaxis option when compared with LMWH once a day 5.
Comparison with Other Anticoagulants
- The new anticoagulants, including apixaban, rivaroxaban, and dabigatran, did not differ significantly for efficacy and safety in direct or indirect comparisons 6.
- A higher efficacy of new anticoagulants was generally associated with a higher bleeding tendency 6.
- Additional comparative efficacy and tolerability data are required to definitively position apixaban with respect to other anticoagulants 3.