Treatment of Pulmonary Embolism with Apixaban

Initial Assessment and Treatment

No dose adjustment is required for a patient with a creatinine clearance of 75 mL/min, as dose adjustments are only necessary for patients with severe renal impairment (CrCl <30 mL/min), according to the European Society of Cardiology 1, 2

Non-vitamin K antagonist oral anticoagulants (NOACs) like apixaban are recommended over vitamin K antagonists (VKAs) when treating PE in patients eligible for NOACs, as stated by the European Society of Cardiology 2
Apixaban offers the advantage of fixed dosing without the need for routine laboratory monitoring, as recommended by the European Society of Cardiology 1

The minimum recommended duration of anticoagulation for PE is 3 months, according to the European Society of Cardiology 2
After the initial treatment period, the decision for extended therapy should be based on the risk of recurrence if anticoagulation is discontinued, bleeding risk with continued therapy, and patient preference, as suggested by the European Respiratory Society and the European Society of Cardiology 2, 3

Routine clinical evaluation is recommended 3-6 months after acute PE, as advised by the European Respiratory Society and the European Society of Cardiology 2, 3
Regular assessment of renal function is important, especially in elderly patients, as significant deterioration would require reconsideration of dosing, according to the European Society of Cardiology 1

Although age alone does not require dose adjustment for PE treatment with apixaban, elderly patients may have higher bleeding risk and should be monitored carefully, as recommended by the European Society of Cardiology 1
Apixaban should not be used in patients with severe renal impairment (CrCl <30 mL/min) or severe liver impairment, as stated by the European Society of Cardiology 1, 2
Apixaban is not recommended for patients with antiphospholipid antibody syndrome, where vitamin K antagonists are preferred, according to the European Respiratory Society and the European Society of Cardiology 2, 3