Apixaban Use in Venous Thromboembolism

Introduction to Apixaban Guidelines

The American Society of Hematology suggests using low molecular weight heparin (LMWH) over direct oral anticoagulant (DOAC) therapy for patients with breakthrough venous thromboembolism (VTE) during therapeutic anticoagulation 1

For patients with VTE without antiphospholipid antibodies (aPL), apixaban can be initiated at 10 mg twice daily for the first 7 days, followed by 5 mg twice daily for the remainder of treatment, based on guidelines from the National Comprehensive Cancer Network 2, 3
Apixaban has a category 1 recommendation for deep vein thrombosis (DVT) and pulmonary embolism (PE) treatment in patients without antiphospholipid syndrome (APS), based on high-quality evidence from large randomized controlled trials 2, 3

Apixaban should be avoided in patients with severe hepatic impairment 2, 3
Apixaban should be used with caution in patients with renal dysfunction, as 27% of the drug is eliminated through renal clearance 2, 4
Apixaban is contraindicated in patients with severe renal impairment (CrCl <15 mL/min) 2, 5

For patients with cancer-associated VTE without aPL, apixaban has shown lower or similar rates of recurrent VTE compared with dalteparin 2, 3