What is the dose of apixaban for Pulmonary Embolism treatment after switching from heparin infusion?

From the Guidelines

Apixaban Dosing for Pulmonary Embolism Treatment

Apixaban is initiated at a dose of 10 mg orally twice daily for the first 7 days, followed by a maintenance dose of 5 mg orally twice daily for the treatment of pulmonary embolism (PE) after switching from heparin infusion 1.

• This regimen is applicable after switching from a heparin infusion, which is typically discontinued when apixaban is started, provided that the patient has been adequately anticoagulated with heparin.
• The duration of apixaban treatment is individualized based on the patient's risk of recurrent PE and bleeding, but is typically continued for at least 3 to 6 months.
• It's worth noting that apixaban has been shown to be non-inferior to conventional therapy (enoxaparin/warfarin) in terms of efficacy and possibly safer in terms of major bleeding 1.
• The dosing of apixaban is consistent across different guidelines and studies, with a initial dose of 10 mg orally twice daily for the first 7 days, followed by a maintenance dose of 5 mg orally twice daily 1.

From the FDA Drug Label

2.4 Converting from or to apixaban Switching from anticoagulants other than warfarin (oral or parenteral) to apixaban: Discontinue the anticoagulant other than warfarin and begin taking apixaban at the usual time of the next dose of the anticoagulant other than warfarin.

2 DOSAGE & ADMINISTRATION 2.1 Recommended Dose 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.

The dose of apixaban for Pulmonary Embolism treatment after switching from heparin infusion is:

• 10 mg twice daily for the first 7 days
• 5 mg twice daily after 7 days 2

From the Research

Dose of Apixaban for Pulmonary Embolism Treatment

• The dose of apixaban for pulmonary embolism treatment is initiated at 10 mg twice daily for 7 days, followed by 5 mg twice daily 3.
• This dosing regimen is based on the AMPLIFY study, which showed that apixaban was non-inferior to conventional therapy for treatment of PE/DVT and was associated with significantly fewer bleeding events 3.
• The 2019 guidelines of the European Society of Cardiology (ESC) recommend that all eligible patients should be treated with a non-vitamin K antagonist oral anticoagulant (NOAC), such as apixaban, in preference to a vitamin K antagonist (VKA) 4.
• Extended anticoagulation with apixaban can be done with either a treatment dose (5 mg twice daily) or thromboprophylactic dose (2.5 mg twice daily), which reduces the risk of recurrent venous thromboembolism without increase in the rate of major bleeding 5.

Switching from Heparin Infusion to Apixaban

• Apixaban can be initiated after switching from heparin infusion, and the dose is the same as mentioned above 3.
• The decision to switch from heparin infusion to apixaban should be based on the individual patient's risk of recurrent PE and bleeding, as well as their ability to tolerate oral anticoagulation 4.
• The use of apixaban in patients with pulmonary embolism has been shown to be effective and safe, with a lower risk of bleeding compared to conventional anticoagulation 3, 6.