How to take Eliquis for DVT

In this article:

• What is Eliqius prescribed for?
• Eliqius dosing for DVT
• Eliqius vs. alternatives for DVT
• Safety considerations when taking Eliqius for DVT

In this article

• What is Eliqius prescribed for?
• Eliqius dosing for DVT
• Eliqius vs. alternatives for DVT
• Safety considerations when taking Eliqius for DVT

Eliquis (apixaban) is a prescription blood thinner known as a factor Xa inhibitor. It’s approved by the Food and Drug Administration (FDA) to treat and prevent several types of blood clots in certain situations, including deep vein thrombosis (DVT) in adults. If your healthcare provider has suggested or prescribed Eliquis for DVT, this guide will help you understand the typical dosing schedule and how to take it.

What is Eliqius prescribed for?

Eliquis is FDA approved for the following uses:

• Preventing DVT and pulmonary embolism (PE) in adults who have had hip or knee replacement surgery
• Treating DVT and PE in adults
• Reducing the risk of recurrent DVT and PE in adults after initial treatment
• Treating venous thromboembolism (VTE, which is a catch-all term that describes DVT, PE, and other conditions related to blood clots) in pediatric patients
• Reducing the risk of VTE in pediatric patients after at least five days of initial treatment.
• Reducing the risk of ischemic stroke (when a blood clot blocks blood flow to the brain, causing brain cells to die) in adults with nonvalvular atrial fibrillation (an irregular heartbeat not caused by a heart deformity)
• Reducing the risk of systemic embolism (when a blood clot travels along the bloodstream, gets stuck in a blood vessel, and blocks blood flow to part of the body) in adults with nonvalvular atrial fibrillation

Healthcare providers may also prescribe Eliquis off-label when the medication offers a benefit that isn’t recognized by the FDA. Elizabeth Rubin Ribak, MD, a clinical adviser at Embers Recovery in Phoenix, Arizona, says common off-label uses of Eliquis include:

• Treating or reducing the risk of left ventricular thrombus (when a blood clot forms in the left ventricle of the heart)
• Treating or reducing the risk of cerebral venous sinus thrombosis (when a blood clot forms in a vein leading away from the brain)
• Treating or reducing the risk of cancer-associated thrombosis (people with malignant cancers are up to seven times more likely to develop blood clots)
• Treating or reducing the risk of  arterial thrombosis in peripheral artery disease (blood clots that form around a buildup of cholesterol in the arteries)

Eliqius dosing for DVT

Eliquis dosing for DVT treatment typically starts at 10 mg twice daily for seven days. This higher initial dose helps to prevent existing clots from growing, and new clots can’t form in the meantime. It doesn’t dissolve the clot, though.

After seven days, the dose is typically reduced to 5 mg twice daily for up to six months. During this time, the body should reabsorb any existing clots. Large clots and clots located in “deep veins” (those that run through muscles, far from the surface of the skin) tend to take the longest time to disappear. 

“If a clot was triggered by something temporary—like surgery—we often stop Eliquis after three months,” says Ronald Benitez, MD, a board-certified cerebrovascular and neurointerventional neurosurgeon based in New Jersey. “But for patients with ongoing risk factors or unexplained clots, it’s safer to stay on Eliquis long-term.” Taking 2.5 mg of Eliquis twice daily helps prevent recurrent DVT. 

The recommended dose of Eliquis to prevent DVT after hip or knee replacement surgery is 2.5 mg twice daily. It should be started 12–24 hours after the procedure and continued for 12 days in the case of knee replacement surgery and 35 days in the case of hip replacement surgery. 

Keep in mind that these are general dosing guidelines. Your healthcare provider may also consider other factors, such as your medical history, body weight, and age, when determining a safe Eliquis dosage for DVT.

Eliqius vs. alternatives for DVT

Eliquis is a safer and more convenient DVT treatment than many other anticoagulants. Here’s why:

• Regular blood monitoring isn’t required, unlike with warfarin.
• Eliquis doesn’t need to be taken with food, unlike Xarelto (rivaroxaban), which should be taken with food.
• No diet restrictions are necessary, unlike with warfarin, which requires a consistent amount of vitamin K foods. 
• Some blood thinners need to be taken along with aspirin, but Eliquis does not.
• Eliquis is taken orally, unlike some injection-only anticoagulants, like heparin. 

Eliquis also has a lower risk of bleeding than other medications in its drug class, including Xarelto. If severe bleeding does occur, an injection of Andexxa (andexanet alfa) can reverse Eliquis’ effects and allow blood to clot normally. 

On the downside, Eliquis can be more expensive than alternatives. Even with a SingleCare prescription discount card, a one-month supply of Eliquis costs about $834 for 60, 5 mg tablets. Some other blood thinners, especially those available in generic form, can be less expensive.

RELATED: Eliquis alternatives: What can I take instead of Eliquis?

Safety considerations when taking Eliqius for DVT

Eliquis isn’t right for everyone. Here are some things to keep in mind when talking to a healthcare professional about DVT treatment.

1. Increased risk of bleeding

“The biggest safety discussion is bleeding risk—especially if patients are older or on other blood thinners,” Dr. Benitez says. The risk of severe bleeding is lower with Eliquis than with other DVT medications, but it’s still possible to experience significant blood loss from a minor cut, a nosebleed, or a menstrual cycle while taking this drug.

Another worry is internal bleeding. If you fall, hit your head, or experience some other trauma while taking Eliquis, seek emergency medical attention. 

Other signs of internal bleeding include:

• Bloody stools (may appear black or tarry)
• Bloody urine 
• Vomiting blood or debris that looks like coffee grounds
• Coughing up blood or debris that looks like coffee grounds
• Prolonged nosebleed
• Blood coming out of the ears
• Confusion
• Weakness on one side of the body
• Seizures 
• Severe headache
• Vision problems
• Difficulty breathing
• Chest pain
• Swelling and pain in the abdomen
• Abdominal bruising
• Dizziness
• Fatigue
• Nausea
• Rapid heart rate

Internal bleeding is a medical emergency. If you experience the above symptoms, call 911 or have someone take you to the nearest emergency room.

2. Contraindications and cautions

Eliquis isn’t recommended for people who are pregnant, breastfeeding, or have severe liver problems. It also shouldn’t be taken by people with mechanical heart valves or triple-positive antiphospholipid syndrome. People who have active bleeds should not take Eliquis, and those who are allergic to apixaban or any ingredient in the medication should not take Eliquis.

3. Dosage guidelines

Taking Eliquis exactly as prescribed is critical to ensure your long-term safety. Too much Eliquis increases the risk of uncontrollable bleeding, which is why the higher initial dose is limited to just seven days. On the other hand, too little Eliquis doesn’t effectively prevent clots, so it’s important not to skip a dose.

It’s okay to take Eliquis later than usual if you forget a dose, but don’t take two pills at a time. For example:

• If you forget to take your morning dose of Eliquis but remember it around lunch time, go ahead and take the missed dose. Take your evening dose as usual.
• If you forget the morning dose but don’t remember until about 5 p.m., skip the missed dose and just take your evening dose as usual. 

If you miss a dose and you’re not sure what to do, check with your healthcare provider.

RELATED: Eliquis starter pack directions

4. Drug interactions

Medications known as combined P-gp and strong CYP3A4 inhibitors tend to interact with Eliquis and make it difficult for the body to process and eliminate it. This makes Eliquis more potent and can increase the risk of side effects. Combined P-gp and strong CYP3A4 inhibitors include some antifungals, HIV protease inhibitors, and calcium channel blockers, among many others.   

A group of drugs called combined P-gp and strong CYP3A4 inducers may decrease the amount of Eliquis in the bloodstream, making it less effective. This increases the risk of recurrent DVT. Some anticonvulsants fall into this category. 

Your healthcare provider will evaluate your current medications to identify potential interactions. Some herbal supplements, like St. John’s wort, may also interact with Eliquis, so be sure to tell them about everything you take, including Rx and OTC medicines, vitamins, and supplements. 

Bottom line

The Eliquis dosage for DVT starts higher to immediately stop the growth of the blood clot. After a week, the dose is scaled back to a more sustainable amount for six months. If your healthcare provider recommends staying on Eliquis for long-term DVT prevention, the dose will typically be reduced even further.

Eliquis is a popular anticoagulant because it’s convenient, effective, and considered safer than other options, but it can still have risks. Talk to your healthcare provider to make sure the benefits of taking Eliquis for DVT outweigh the risks.