Eliquis (Apixaban) Treatment Dose for Pulmonary Embolism
For acute PE treatment, start apixaban 10 mg orally twice daily for the first 7 days, then reduce to 5 mg twice daily for at least 3 months. 1
Initial Treatment Phase (Days 1-7)
- Apixaban 10 mg orally twice daily for 7 days is the FDA-approved loading dose for acute PE treatment 1
- No parenteral anticoagulation (heparin or enoxaparin) is required before starting apixaban, unlike dabigatran or edoxaban 2, 3
- Treatment can be initiated immediately upon PE diagnosis 3
Maintenance Phase (After Day 7)
- Reduce to 5 mg orally twice daily after completing the initial 7-day loading phase 1
- Continue this maintenance dose for a minimum of 3 months 2
- For unprovoked PE or ongoing risk factors, extended anticoagulation beyond 3 months may be necessary 3
Key Advantages Over Traditional Therapy
- Apixaban demonstrated superior safety with major bleeding rates of 0.6% versus 1.8% with conventional enoxaparin/warfarin therapy 2
- The composite of major bleeding and clinically relevant non-major bleeding was significantly lower: 4.3% with apixaban versus 9.7% with conventional therapy 2
- Efficacy was non-inferior to conventional therapy for preventing recurrent VTE (relative risk 0.84; 95% CI 0.60-1.18) 2
Critical Dosing Pitfalls to Avoid
- Never continue the 10 mg twice daily dose beyond 7 days - this increases bleeding risk without additional benefit 3
- Do not administer parenteral anticoagulation when initiating apixaban, as this unnecessarily increases bleeding risk 3
- Do not double a missed dose - if a dose is missed, take it as soon as possible on the same day and resume the regular twice-daily schedule 1
Special Populations Requiring Dose Adjustment
Severe Renal Impairment
- Use with caution if creatinine clearance is <30 mL/min 2, 3
- Apixaban is contraindicated if creatinine clearance is <15 mL/min 2
Drug Interactions
- Reduce dose by 50% when coadministered with combined P-glycoprotein and strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) if taking 10 mg or 5 mg twice daily 1
- Avoid coadministration entirely if already taking 2.5 mg twice daily 1
Hepatic Impairment
- Avoid in patients with significant hepatic dysfunction (transaminases >2× upper limit of normal or total bilirubin >1.5× upper limit of normal) 2
Extended Secondary Prevention (After Initial 6 Months)
- For patients requiring extended anticoagulation beyond 6 months, the dose is 2.5 mg orally twice daily 1
- This reduced dose is specifically for secondary prevention after completing at least 6 months of treatment 1
Clinical Context
The AMPLIFY trial enrolled 5,395 patients with acute VTE (1,836 with PE), demonstrating that apixaban's single-drug approach eliminates the complexity of bridging therapy and INR monitoring required with warfarin 2. This simplified regimen may reduce hospital length of stay compared to conventional therapy 2, making it particularly suitable for outpatient PE management in hemodynamically stable patients 2, 4.