Extended low-intensity anticoagulant therapy for VTE
Extended low-intensity anticoagulant therapy may be appropriate following a first episode of unprovoked proximal DVT or PE, or if the patient has a persistent provoking factor for proximal DVT or PE (eg estrogen-containing therapy, inflammatory bowel disease). If untreated, a first episode of unprovoked proximal DVT or PE has a recurrence rate of approximately 10% at 1 year and 36% at 10 yearsKhan, 2019.
Suitable extended low-intensity anticoagulant regimens for VTE are:
1apixaban (CrCl 25 mL/min or more) 2.5 mg orally, twice daily apixaban apixaban apixaban
OR
1rivaroxaban (CrCl 15 mL/min or more) 10 mg orally, once daily. rivaroxaban rivaroxaban rivaroxaban
Do not use apixaban if calculated creatinine clearance (CrCl) is less than 25 mL/min. At the time of writing, rivaroxaban has been studied in a limited number of VTE patients with a CrCl of 15 to 29 mL/min; only consider its use in these patients under specialist adviceAgeno, 2016Prins, 2014. Do not use rivaroxaban if CrCl is less than 15 mL/min.
Periodically reassess the patient’s risk of a thromboembolic event versus risk of bleeding (eg annually or when their clinical condition changes), to ensure that the drug and dose are still appropriate.