From the FDA Drug Label
Apixaban is a factor Xa inhibitor indicated: to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. (1.1) for the prophylaxis of deep vein thrombosis (DVT), which may lead to pulmonary embolism (PE), in patients who have undergone hip or knee replacement surgery. (1.2) for the treatment of DVT and PE, and for the reduction in the risk of recurrent DVT and PE following initial therapy. (1.3,1.4,1.5) The patient with a non-occlusive thrombus may be considered for treatment with apixaban (Eliquis) if the thrombus is a DVT or PE, as the drug label indicates it is used for the treatment of DVT and PE 1. However, the label does not explicitly mention non-occlusive thrombus, so caution should be exercised.
- The decision to use apixaban should be made on a case-by-case basis, considering the individual patient's risk factors and medical history.
- It is essential to consult the patient's healthcare provider to determine the best course of treatment.
From the Research
A patient with a non-occlusive thrombus should be considered for treatment with Eliquis (apixaban) as it has been shown to be safe and effective in preventing clot progression and potential complications, as supported by the most recent and highest quality study 2.
Key Considerations
- The decision to use Eliquis should be made by a healthcare provider after careful evaluation of the individual case, taking into account the patient's renal function, age, and other risk factors.
- Eliquis is typically prescribed at 5 mg twice daily, but a reduced dose of 2.5 mg twice daily may be appropriate for patients with severe renal impairment, as shown in the study 2.
- Treatment duration depends on the thrombus location, underlying cause, and risk factors, ranging from 3 months to indefinite therapy.
- Patients should take Eliquis with or without food at approximately the same times each day, and should not stop taking it without consulting their doctor due to increased stroke risk.
Safety and Efficacy
- The study 2 found no difference in time to composite bleeding events or recurrent VTE between apixaban and warfarin in patients with severe renal impairment.
- Apixaban was associated with a significantly reduced incidence of anticoagulation-related ED admission compared to warfarin, as shown in the study 2.
- Other studies, such as 3 and 4, also support the safety and efficacy of apixaban in patients with severe renal impairment.
Monitoring and Follow-up
- Regular follow-up appointments are essential to monitor treatment effectiveness and assess for bleeding complications, which are the main risk of anticoagulation therapy.
- Patients should be monitored for signs of bleeding throughout the duration of therapy, as recommended in the study 4.