Eliquis (Apixaban) Dosing for DVT Treatment
For acute DVT treatment in adults with normal renal function, start apixaban at 10 mg orally twice daily for 7 days, then reduce to 5 mg orally twice daily for at least 3 months. 1
Initial Treatment Phase (Days 1-7)
- Apixaban 10 mg orally twice daily for the first 7 days provides rapid anticoagulation without requiring initial parenteral anticoagulation (heparin bridge). 2, 3, 1
- This loading dose regimen achieves therapeutic anticoagulation quickly and has demonstrated non-inferiority to conventional enoxaparin/warfarin therapy with significantly lower major bleeding rates (0.6% vs 1.8%, P<0.001). 2, 4
- The 7-day lead-in period should be completed as prescribed; shortened durations following parenteral anticoagulation have been associated with increased bleeding risk. 5
Maintenance Phase (After Day 7)
- Transition to apixaban 5 mg orally twice daily after completing the 7-day loading dose. 2, 3, 1
- Continue this maintenance dose for at least 3 months for provoked DVT (with identifiable reversible risk factors). 2, 3
- For unprovoked DVT or persistent risk factors, strongly consider extended anticoagulation beyond 3 months. 2, 3
Extended Treatment Phase (Beyond 6 Months)
- Reduce to apixaban 2.5 mg orally twice daily for long-term secondary prevention if continuing anticoagulation beyond 6 months. 2, 6, 1
- This reduced dose minimizes bleeding risk while maintaining efficacy for preventing recurrent DVT. 2, 6
- Both the 2.5 mg and 5 mg twice-daily doses have demonstrated similar efficacy for extended prevention without increased major bleeding compared to placebo. 7
Critical Dosing Considerations
Renal Function
- No dose adjustment needed for creatinine clearance ≥15 mL/min. 3
- Avoid apixaban in severe renal impairment (CrCl <15 mL/min) as these patients were excluded from clinical trials. 3, 6
Drug Interactions
- Reduce dose by 50% when coadministered with combined P-glycoprotein and strong CYP3A4 inhibitors (ketoconazole, itraconazole, ritonavir) for patients on 5 mg or 10 mg twice daily. 1
- Avoid coadministration in patients already taking 2.5 mg twice daily with these inhibitors. 1
Hepatic Impairment
- Avoid apixaban in significant hepatic impairment (transaminases >2x upper limit of normal or total bilirubin >1.5x upper limit of normal). 6
Special Populations
Cancer-Associated DVT
- Apixaban is an acceptable alternative to LMWH in cancer patients using the same dosing regimen: 10 mg twice daily for 7 days, then 5 mg twice daily. 7, 2
- The recommendation for direct oral anticoagulants including apixaban has been upgraded to grade 1A based on multiple randomized trials demonstrating non-inferiority to LMWH. 7
Administration Options
- For patients unable to swallow whole tablets, apixaban may be crushed and suspended in water, D5W, or apple juice, or mixed with applesauce and administered promptly. 1
- Alternatively, tablets may be crushed and suspended in 60 mL of water or D5W and delivered through a nasogastric tube. 1
Common Pitfalls to Avoid
- Do not skip the 7-day loading dose when initiating apixaban without prior parenteral anticoagulation—this is essential for achieving rapid therapeutic anticoagulation. 1, 5
- Do not double the dose to make up for a missed dose; take the missed dose as soon as possible on the same day and resume twice-daily administration. 1
- Do not use the reduced 2.5 mg dose for initial treatment or maintenance therapy before 6 months—this dose is only for extended secondary prevention. 1