Apixaban and rivaroxaban for VTE treatment
Apixaban and rivaroxaban (oral factor Xa inhibitors) are preferred over dabigatran or warfarin to treat venous thromboembolism (VTE) (ie deep vein thrombosis [DVT] or pulmonary embolism [PE]). Apixaban and rivaroxaban do not require concurrent parenteral anticoagulation when starting therapy, nor routine anticoagulation monitoring. However, it is vital to use the correct dose because underdosing may not provide adequate anticoagulation.
To treat VTE, use:
1apixaban (CrCl 25 mL/min or more) 10 mg orally, twice daily for 7 days, then decrease to 5 mg twice daily. For duration of therapy, see Duration of anticoagulant therapy for VTE. apixaban apixaban apixaban
OR
1rivaroxaban (CrCl 30 mL/min or more) 15 mg orally, twice daily for 21 days, then decrease to 20 mg once daily. For duration of therapy, see Duration of anticoagulant therapy for VTE. 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 advice from a specialistAgeno, 2016Prins, 2014. Do not use rivaroxaban if CrCl is less than 15 mL/min.
For further information, including management of bleeding, see apixaban or rivaroxaban.
Direct-acting oral anticoagulants (DOACs) (particularly apixaban and rivaroxaban) have been associated with heavy menstrual bleeding compared with warfarin or low molecular weight heparin (LMWH)Beyer-Westendorf, 2021.
If using a DOAC in a patient with obesity, see also Direct-acting oral anticoagulants (DOACs) for VTE prophylaxis and treatment in patients with obesity.