What is the most appropriate loading-dose schedule for apixaban in the treatment of acute DVT/PE?

• A. 5 mg twice daily for 1 week
• B. 10 mg twice daily for 7 days
• C. 15 mg twice daily for 7 days
• D. 20 mg twice daily for 7 days

Answer: (B)

Achieving therapeutic anticoagulation quickly is crucial in acute DVT/PE, so apixaban uses a loading phase to reach effective levels without requiring parenteral bridging. The best loading-dose schedule is 10 mg twice daily for 7 days, after which you switch to the maintenance dose of 5 mg twice daily for ongoing treatment. This approach provides strong initial anticoagulation to prevent clot progression or embolization, then reduces exposure to lower bleeding risk once therapeutic levels are established.

The other options either underdose during the critical first week, risking ongoing thrombosis, or overdose, increasing bleeding risk. After the loading period, the standard maintenance dose is 5 mg twice daily, with dose adjustments only for specific patient factors (e.g., some patients may require 2.5 mg twice daily for extended therapy).