How do you approach a patient with recurrent VTE who develops VTE again after reduction of apixaban to 2.5 mg bid?
Would you consider increasing the dose to the usual 5 mg BID or consider it a DOAC failure and switch to coumadin?
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How do you approach a patient with recurrent VTE who develops VTE again after reduction of apixaban to 2.5 mg bid?
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2 Answers
Mednet Member
Pulmonology · University of Kentucky Medical Center
Answered on
Several factors play into this decision for me.
- Is the patient obese? Obese patients tend to give me pause for dose-reduction of DOACs. As such, half-dose apixaban may have been relatively underdosed for an obese patient and I would not call it DOAC failure, rather I would increase the dose to usual 5 mg BID.
- Have the VTE events been provoked or unprovoked?
- If unprovoked, has a hypercoagulability workup been obtained to rule out conditions that warrant coumadin use (e.g. LA, antiphospholipid antibodies, single, double or triple positive)?
- Have other conditions causing a hypercoagulable state been ruled out that may give pause when considering half dose DOAC in the future (e.g. protein C, S, antithrombin deficiency, FVL)? Given the recurren...
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Mednet MemberInvited Expert
Pulmonology · Temple University Hospital
Answered on
Full dose for the rest of their life.
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