What is the recommended length of treatment and dose with apixaban (Apixaban) for Pulmonary Embolism (PE)?

From the Guidelines

Apixaban for pulmonary embolism (PE) should be prescribed at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months, with treatment duration individualized based on the patient's bleeding risk versus recurrence risk, as recommended by the 2019 ESC guidelines 1.

Treatment Duration and Dose

The standard treatment duration is 3-6 months for provoked PE (caused by temporary risk factors like surgery or immobilization). For unprovoked PE or patients with ongoing risk factors, extended treatment beyond 6 months may be necessary, potentially indefinitely.

• The dose of apixaban is typically 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months.
• After the initial treatment period, patients continuing long-term therapy may be considered for a reduced dose of 2.5 mg twice daily to minimize bleeding risk while maintaining protection, as seen in studies comparing apixaban to conventional therapy 1.

Individualized Treatment Decisions

Treatment decisions should be individualized based on the patient's bleeding risk versus recurrence risk.

• Apixaban should be taken with or without food at approximately 12-hour intervals.
• Dose adjustments are needed for patients with severe renal impairment, low body weight (≤60 kg), or age ≥80 years.
• Regular monitoring for bleeding complications is essential, though routine coagulation monitoring is not required, as noted in the 2014 ESC guidelines 1.

Patient Education

Patients should be educated about bleeding signs and the importance of medication adherence.

• The results of trials using NOACs in the treatment of VTE indicate that these agents are non-inferior (in terms of efficacy) and possibly safer (particularly in terms of major bleeding) than the standard heparin/VKA regimen, as seen in studies comparing apixaban to conventional therapy 1.

From the FDA Drug Label

Treatment of DVT and PE The recommended dose of apixaban tablets is 10 mg taken orally twice daily for the first 7 days of therapy. After 7 days, the recommended dose is 5 mg taken orally twice daily. Reduction in the Risk of Recurrence of DVT and PE The recommended dose of apixaban tablets is 2.5 mg taken orally twice daily after at least 6 months of treatment for DVT or PE

The length of treatment with apixaban for Pulmonary Embolism (PE) is at least 6 months, after which the dose can be reduced to 2.5 mg twice daily for the reduction in the risk of recurrence of DVT and PE 2.

• The initial dose is 10 mg twice daily for the first 7 days.
• After 7 days, the dose is reduced to 5 mg twice daily.
• After at least 6 months, the dose can be reduced to 2.5 mg twice daily for the reduction in the risk of recurrence.

From the Research

Length of Treatment and Dose with Apixaban for PE

• The length of treatment and dose with apixaban for pulmonary embolism (PE) can vary depending on the patient's condition and medical history 3, 4, 5.
• According to a study published in 2022, first-line therapy for PE consists of direct oral anticoagulants such as apixaban, edoxaban, rivaroxaban, or dabigatran, with thrombolysis reserved for patients with systolic blood pressure lower than 90 mm Hg 3.
• A study published in 2018 found that extended anticoagulation with apixaban, either at a treatment dose (5 mg twice daily) or thromboprophylactic dose (2.5 mg twice daily), reduces the risk of recurrent venous thromboembolism without increasing the rate of major bleeding 4.
• Another study published in 2025 found that extended anticoagulation with reduced-dose apixaban (2.5 mg twice daily) was noninferior to full-dose apixaban (5.0 mg twice daily) for the prevention of recurrent venous thromboembolism in patients with active cancer, and the reduced dose led to a lower incidence of clinically relevant bleeding complications 5.
• The optimal duration of treatment with apixaban for PE is not well established, but it is generally recommended to continue treatment for at least 3-6 months, and possibly longer in patients with a high risk of recurrence 6, 7.

Dosing Regimens

• The standard dosing regimen for apixaban in the treatment of PE is 10 mg twice daily for the first 7 days, followed by 5 mg twice daily 3, 4.
• However, some studies have investigated the use of reduced-dose apixaban (2.5 mg twice daily) for extended anticoagulation, which may be associated with a lower risk of bleeding complications 5.
• The choice of dosing regimen should be individualized based on the patient's risk factors, medical history, and other clinical considerations 6, 7.