What is the recommended dose of Eliquis (apixaban) for a patient with Deep Vein Thrombosis (DVT) who has started Eliquis taper?

Apixaban Dosing for DVT Treatment

For a patient with DVT starting Eliquis (apixaban), initiate 10 mg orally twice daily for 7 days, then reduce to 5 mg orally twice daily for at least 3 months. 1, 2, 3

Initial Treatment Phase (Days 1-7)

• Start with 10 mg orally twice daily for the first 7 days as the loading dose regimen to achieve rapid anticoagulation 1, 2, 3
• No initial parenteral anticoagulation (heparin or LMWH) is required before starting apixaban, unlike warfarin or edoxaban 2
• This loading dose 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, 2

Maintenance Phase (Day 8 onwards)

• After 7 days, reduce to 5 mg orally twice daily 1, 2, 3
• Continue this dose for at least 3 months for provoked DVT 2
• For unprovoked DVT or patients with ongoing risk factors, consider treatment duration beyond 3 months 2

Extended Treatment Phase (After 6 months)

If extended anticoagulation is indicated after completing at least 6 months of treatment:

• Reduce to 2.5 mg orally twice daily for secondary prevention 4, 2, 3
• This reduced dose minimizes bleeding risk while maintaining efficacy for preventing recurrent DVT 2
• The 2021 CHEST guidelines suggest using reduced-dose apixaban over full-dose for extended-phase anticoagulation 4
• Extended-phase anticoagulation does not have a predefined stop date but should be reevaluated at least annually 4

Critical Dosing Considerations

Renal Impairment

• Avoid apixaban in severe renal impairment (CrCl <15 mL/min) 1, 2
• Use caution with CrCl <25 mL/min 2

Hepatic Impairment

• Avoid in significant hepatic impairment (transaminases >2x upper limit of normal or total bilirubin >1.5x upper limit of normal) 2

Missed Dose

• If a dose is missed, take it as soon as possible on the same day and resume twice-daily administration 3
• Do not double the dose to make up for a missed dose 3

Common Pitfalls to Avoid

• Do not use initial parenteral anticoagulation (heparin/LMWH) before starting apixaban—this is a key advantage over warfarin and edoxaban 2
• Do not skip the 7-day loading phase at 10 mg twice daily; jumping directly to 5 mg twice daily is inadequate for acute DVT treatment 1, 3
• Do not continue 10 mg twice daily beyond 7 days for standard DVT treatment; this increases bleeding risk without additional benefit 3
• Routine laboratory monitoring (PT/INR, aPTT) is not required or useful for apixaban dosing adjustments 1