Apixaban Treatment for Deep Vein Thrombosis

Initial Treatment Phase

The American College of Chest Physicians suggests that apixaban 10 mg orally twice daily eliminates the need for initial parenteral anticoagulation, simplifying treatment compared to traditional warfarin-based therapy for acute DVT treatment during the first week 1

The American College of Chest Physicians recommends apixaban 5 mg orally twice daily after completing the initial 7-day period for the remainder of the 3-month initial treatment period 1
The 2016 American College of Chest Physicians guidelines suggest DOACs like apixaban over vitamin K antagonists for DVT treatment in non-cancer patients 1

The American College of Chest Physicians suggests reduced-dose apixaban (2.5 mg twice daily) over full-dose (5 mg twice daily) for extended therapy, as it reduces bleeding risk by 10 events per 1,000 cases while adding only 2 more recurrent VTE events per 1,000 cases 2
Extended anticoagulation should be reassessed at least annually, according to the American College of Chest Physicians 2
For provoked DVT (surgery or transient risk factor), the American College of Chest Physicians recommends stopping anticoagulation at 3 months rather than continuing extended therapy 1

No routine laboratory monitoring is required for apixaban, unlike warfarin, according to the American College of Chest Physicians 1
The American College of Chest Physicians recommends avoiding concomitant NSAIDs, antiplatelet agents, or other anticoagulants, as these substantially increase bleeding risk 3

The American College of Cardiology recommends resuming apixaban at the maintenance dose of 5 mg twice daily after an interruption, without re-loading, as there is no evidence to support re-loading after treatment gaps, in patients who have completed the initial 7-day loading dose regimen 4, 5, 6

The American College of Cardiology advises against using bridging therapy with parenteral anticoagulation when restarting apixaban after an interruption, as it is not indicated for patients with a history of VTE 4, 5

The American College of Cardiology recommends evaluating thrombotic risk in patients with a history of VTE, particularly if the original event was unprovoked, as a 14-day gap in anticoagulation increases the risk of recurrent VTE, and VTE within 3 months of anticoagulation interruption is considered high thrombotic risk 4, 5
The American College of Cardiology suggests that each day without anticoagulation increases thrombotic risk, especially given the recent VTE history, and therefore recommends against delaying restarting apixaban 5