Drug interactions
Acetylsalicylic acid + Apixaban
Severity: Major
Acetylsalicylic acid and Apixaban: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Combining aspirin with apixaban increases the risk of bleeding, including major and gastrointestinal bleeding. Although the combination is sometimes needed in patients with cardiovascular disease, the added bleeding risk is clinically important.
What this interaction means in plain words
Acetylsalicylic acid and Apixaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Acetylsalicylic acid belongs to Musculoskeletal; Apixaban belongs to Cardiovascular.
Why it happens
Additive effects of platelet inhibition by aspirin and factor Xa inhibition by apixaban, along with aspirin-related gastric mucosal injury.
What to do
Use the combination only when there is a clear indication, at the lowest aspirin dose and shortest duration, and consider gastroprotection. Monitor for signs of bleeding and avoid chronic higher-dose aspirin.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Acetylsalicylic acid
- Acetylsalicylic acid + Ketorolac Contraindicated
- Acetylsalicylic acid + Ketorolac intranasal Contraindicated
- Abciximab + Acetylsalicylic acid Major
- Acemetacin + Acetylsalicylic acid Major
- Acetazolamide + Acetylsalicylic acid Major
- Acetylsalicylic acid + Alteplase Major
Other interactions of Apixaban
- Apixaban + Dabigatran Contraindicated
- Apixaban + Defibrotide Contraindicated
- Apixaban + Edoxaban Contraindicated
- Apixaban + Ketorolac Contraindicated
- Apixaban + Mifepristone Contraindicated
- Abciximab + Apixaban Major
Frequently asked questions
Can I take Acetylsalicylic acid with Apixaban?
MediHelp rates the interaction as major. Acetylsalicylic acid and Apixaban can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Combining aspirin with apixaban increases the risk of bleeding, including major and gastrointestinal bleeding. Although the combination is sometimes needed in patients with cardiovascular disease, the added bleeding risk is clinically important.
How serious is the interaction between Acetylsalicylic acid and Apixaban?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the combination only when there is a clear indication, at the lowest aspirin dose and shortest duration, and consider gastroprotection. Monitor for signs of bleeding and avoid chronic higher-dose aspirin.
What other medicines interact with Acetylsalicylic acid?
MediHelp also lists interactions of Acetylsalicylic acid with, for example, Ketorolac, Ketorolac intranasal, Abciximab. The full list is on the Acetylsalicylic acid page.
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