Low-dose DOACs in VTE

Dr Mark Crowther is a professor and chair of the Department of Medicine and the Leo Pharma Chair in Thromboembolism Research at McMaster University.

Could you comment on the use of low-dose direct oral anticoagulants (DOACs) in venous thromboembolism (VTE)?

Mark Crowther, MD, MSc: Low-dose direct oral anticoagulants (DOACs), both apixaban and rivaroxaban, have been studied for the long-term secondary prevention of VTE. Interestingly, the results are a little bit different.

For apixaban the study showed, I would say, very good results. When a patient is on apixaban at the dose of 5 mg orally (PO) twice daily (bid), which is the usual dose, I think most of us now would drop them back to 2.5 mg bid at 6 months, based on the results of the extension study [AMPLIFY-EXT] for apixaban.

For rivaroxaban the study was not as clear. Dropping from the 20 mg to the 10 mg was not clearly associated with net patient benefit.

In my own practice I generally do not reduce the dose of rivaroxaban, but I do reduce the dose of apixaban. And you can be confident that at the reduced dose apixaban is associated with a low risk of recurrent thrombosis and a very nice, low risk of bleeding.