Apixaban Dosing: 10 mg BID for 7 Days Then 5 mg BID Thereafter
Yes, the dosing regimen of apixaban 10 mg twice daily for 7 days followed by 5 mg twice daily thereafter is correct and represents the FDA-approved and guideline-endorsed standard for treating acute venous thromboembolism (VTE). This regimen applies specifically to the initial treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) in patients without cancer-associated thrombosis.
Evidence Supporting This Regimen
The AMPLIFY trial established this dosing schedule as the standard approach for acute VTE treatment 1. The 10 mg BID loading phase for the first 7 days achieves rapid therapeutic anticoagulation, while the subsequent 5 mg BID maintenance phase provides sustained protection against recurrent thrombosis with a favorable bleeding profile 1.
Key Clinical Outcomes
Recurrent VTE: The apixaban regimen (10 mg BID × 7 days → 5 mg BID) demonstrated comparable efficacy to enoxaparin/warfarin, with 19 recurrent events per 1,000 patients versus 23 per 1,000 with conventional therapy (4 fewer per 1,000,95% CI: 9 fewer to 4 more) 1
Major bleeding: Apixaban showed superior safety with 18 major bleeding events per 1,000 versus 31 per 1,000 with enoxaparin/warfarin—a reduction of 13 fewer bleeds per 1,000 (95% CI: 8 fewer to 15 fewer) 1
Mortality: All-cause mortality was similar between groups (27 per 1,000 with apixaban versus 31 per 1,000 with conventional therapy) 1
Critical Implementation Details
Duration of Therapy
- Initial phase: Exactly 7 days at 10 mg BID—do not extend or shorten this loading period 1
- Continuation phase: 5 mg BID for a minimum of 6 months total treatment duration 1
- The 6-month duration applies to most patients with provoked or unprovoked VTE; extended therapy decisions should be made after completing the initial 6 months 1
Special Populations Requiring Different Approaches
Cancer-associated thrombosis: The CHEST guidelines suggest LMWH over apixaban (Grade 2C) for the first 3 months in patients with active malignancy, as the apixaban trials included only 5% of patients with cancer 1. If apixaban is used in cancer patients, the standard 10 mg BID × 7 days → 5 mg BID regimen still applies, but LMWH remains preferred.
Renal impairment: No dose adjustment is required for the standard regimen unless creatinine clearance falls below 15 mL/min, in which case apixaban is not recommended 1.
Common Pitfalls to Avoid
Do not use 2.5 mg BID dosing for acute VTE treatment: The 2.5 mg BID dose is reserved only for extended prophylaxis after completing at least 6 months of full-dose anticoagulation, not for initial treatment 1
Do not bridge with parenteral anticoagulation: Unlike warfarin or edoxaban, apixaban does not require initial heparin or LMWH bridging—the 10 mg BID loading dose provides immediate therapeutic effect 1
Do not confuse with rivaroxaban dosing: Rivaroxaban uses 15 mg BID × 21 days then 20 mg daily, which is a different schedule entirely 1
Do not stop at 7 days: The 7-day period is only the loading phase; patients must continue with 5 mg BID for the full treatment course (minimum 6 months) 1