From the Guidelines
For new deep vein thrombosis (DVT), the recommended Eliquis (apixaban) dosing is 10 mg taken orally twice daily for the first 7 days, followed by 5 mg twice daily for at least 3 months. This medication should be taken with or without food at approximately 12-hour intervals. It's essential to not miss any doses to maintain consistent blood levels for effective anticoagulation. Patients should avoid taking NSAIDs, aspirin, or other blood thinners unless specifically directed by their healthcare provider due to increased bleeding risk. If a dose is missed, it should be taken as soon as remembered unless it's close to the next scheduled dose. Eliquis works by inhibiting Factor Xa, which prevents thrombin formation and clot development. This dual-phase dosing approach provides intensive initial anticoagulation when the clot burden is highest, followed by a maintenance dose to prevent recurrence while balancing bleeding risk. Treatment duration beyond 3 months depends on individual risk factors for recurrence and bleeding, requiring physician assessment, as supported by the most recent guidelines 1. The use of apixaban has been shown to be effective and safe in clinical trials, with a lower risk of major bleeding compared to conventional therapy 1. Additionally, the American Society of Hematology guidelines suggest that the standard dose or a lower dose of rivaroxaban or apixaban may be used for secondary prevention of VTE, but more research is needed to determine which patients can safely use a lower-dose DOAC 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.
- In patients with upper extremity deep vein thrombosis (UEDVT), low-dose apixaban (2.5 mg twice daily) or rivaroxaban (10 mg daily) may be used as secondary prophylaxis, with preliminary data suggesting no thromboembolic events or hemorrhagic events during treatment with low-dose DOACs 4.
- The efficacy and safety of rivaroxaban versus warfarin in the management of unusual site deep vein thrombosis have been evaluated, with rivaroxaban exhibiting comparable efficacy and a lower risk of bleeding complications and major bleeding 5.
- Apixaban has been reviewed for the prophylaxis and treatment of deep vein thrombosis and pulmonary embolism, with evidence suggesting its effectiveness and safety in these indications 6.
- Real-world prescribing practices of apixaban or rivaroxaban lead-in doses for the treatment of venous thromboembolism in hospitalized patients have been described, with variable prescribing patterns and a need for larger cohorts to define the safety and efficacy of lead-in reduction 7.