From the Guidelines
For VTE prophylaxis, the standard Eliquis (apixaban) dose is 2.5 mg taken orally twice daily, as recommended by the most recent guidelines 1. This dosing regimen should typically begin 12-24 hours after surgery for patients undergoing hip or knee replacement surgery and continue for 35 days after hip replacement or 12 days after knee replacement. For hospitalized medically ill patients at risk for VTE, the same 2.5 mg twice daily dose is recommended for the duration of the hospital stay and post-discharge period, typically 6-14 days and not exceeding 30 days. Some key points to consider when using Eliquis for VTE prophylaxis include:
- No dose adjustment is needed for most patients, but caution is advised in those with severe renal impairment (CrCl 15-29 mL/min) 1.
- Eliquis works by selectively inhibiting factor Xa, preventing thrombin formation and clot development.
- It has predictable pharmacokinetics with twice-daily dosing providing consistent anticoagulation.
- Patients should take missed doses as soon as remembered on the same day, but should never take a double dose to make up for a missed one.
- Regular monitoring of bleeding risk is important throughout treatment, as the risk of bleeding is a concern with all anticoagulants, including Eliquis 1. The American Society of Hematology guidelines also support the use of apixaban for VTE prophylaxis, with a recommended dose of 2.5 mg twice daily 1. Additionally, the ASCO clinical practice guideline update recommends apixaban 2.5 mg orally twice daily for VTE prophylaxis in patients with cancer 1. Overall, the evidence supports the use of Eliquis 2.5 mg twice daily for VTE prophylaxis, with careful consideration of patient-specific factors such as renal function and bleeding risk.
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. • In patients undergoing knee replacement surgery, the recommended duration of treatment is 12 days
The recommended dose of Eliquis (apixaban) for VTE prophylaxis is 2.5 mg taken orally twice daily. The initial dose should be taken 12 to 24 hours after surgery. The recommended duration of treatment is 35 days for patients undergoing hip replacement surgery and 12 days for patients undergoing knee replacement surgery 2.
From the Research
Eliquis Dose for VTE Prophylaxis
- The optimal dose of apixaban (Eliquis) for venous thromboembolism (VTE) prophylaxis is not explicitly stated in the provided studies, but the studies suggest that a lower dose of apixaban (2.5 mg twice daily) may be effective and safe for extended phase therapy 3, 4, 5.
- A study comparing the effectiveness and safety of low-dose (2.5 mg twice daily) versus full-dose (5 mg twice daily) apixaban for extended phase oral anticoagulation in patients with VTE found no significant differences in recurrent VTE or major bleeding events between the two groups 3.
- Another study evaluating the efficacy and safety of low-dose apixaban (2.5 mg twice daily) or rivaroxaban (10 mg daily) for VTE secondary prophylaxis in patients at high risk of VTE recurrence found that low-dose DOACs may be effective and safe, with no statistically significant difference in the rate of VTE recurrence and/or bleeding events between the two groups 4.
- A study examining the efficacy and safety of low-dose apixaban or rivaroxaban in major-thrombophilia carriers found that low-dose DOACs may be effective and safe in secondary VTE prophylaxis, with no increase in VTE recurrence and/or bleeding risk 5.
- A real-world evaluation comparing bleeding and recurrent VTE risks with apixaban versus warfarin as outpatient treatment found that apixaban was associated with lower risks of bleeding and recurrent VTE 6.