From the Guidelines
For new deep vein thrombosis (DVT), Eliquis (apixaban) is typically dosed at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This recommendation is based on the most recent and highest quality study available, which prioritizes morbidity, mortality, and quality of life as the outcome 1. The dosing regimen should be adjusted according to the patient's kidney function, with dose reductions for severe renal impairment. Patients should be counseled to avoid missing doses and to inform all healthcare providers about taking this blood thinner before any procedures.
Some key points to consider when prescribing Eliquis for new DVT include:
- The medication should be taken with or without food at approximately 12-hour intervals
- Baseline kidney and liver function tests are necessary before starting Eliquis, as dose adjustments may be needed for severe renal impairment
- Bleeding is the main side effect to watch for, including unusual bruising, nosebleeds, blood in urine or stool, or severe headaches
- Patients should avoid other blood thinners, including NSAIDs and aspirin, unless specifically directed by their doctor
- Eliquis works by inhibiting Factor Xa, preventing the formation of blood clots while allowing the body to gradually dissolve the existing DVT
- Regular follow-up appointments are important to monitor treatment effectiveness and determine the appropriate duration of therapy based on whether the DVT was provoked by a temporary risk factor or is unprovoked.
It's worth noting that other studies, such as 1 and 1, also support the use of apixaban for the treatment of DVT, but the most recent and highest quality study 1 provides the strongest evidence for this recommendation. Additionally, the American Society of Hematology 2020 guidelines for management of venous thromboembolism also support the use of apixaban for the treatment of DVT 1.
From the FDA Drug Label
The recommended dose of apixaban tablets for the treatment of DVT 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 recommended dose of apixaban (Eliquis) for new DVT is:
- 10 mg twice daily for the first 7 days
- 5 mg twice daily after 7 days 2
From the Research
Eliquis Dosing for New DVT
- The traditional treatment of venous thromboembolism (VTE) with heparin and warfarin has numerous limitations, and new oral anticoagulants like apixaban represent a promising alternative 3.
- Apixaban is an oral factor Xa inhibitor with a rapid onset of action and predictable pharmacokinetics, allowing for a fixed dose regimen 3.
- A fixed-dose regimen of oral apixaban alone is as effective as conventional treatment regimens and is associated with a clinically relevant reduction of major bleeding 3.
- Extended anticoagulation with apixaban at either 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 3.
Comparison with Other Anticoagulants
- Rivaroxaban has been compared to warfarin in the management of unusual site deep vein thrombosis, and it exhibited comparable efficacy with a lower risk of bleeding complications and major bleeding 4.
- Apixaban has been compared to rivaroxaban for the prevention of recurrent venous thromboembolism and adverse bleeding events, and apixaban seems to be more effective in preventing recurrent venous thromboembolism and major bleeding events 5.
Dosing Regimens
- The treatment dose of apixaban is 5 mg twice daily, and the thromboprophylactic dose is 2.5 mg twice daily 3.
- Low-dose apixaban (2.5 mg twice daily) or rivaroxaban (10 mg daily) may be used for extended anticoagulant therapy in patients with upper extremity deep vein thrombosis and persistent thrombotic risk factors or without affected vein recanalization 6.