Drug interactions
Apixaban + Bivalirudin
Severity: Major
Apixaban and Bivalirudin: major interaction.
Last updated Sources: UK SmPC
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
Both agents inhibit coagulation, so combined use raises the risk of bleeding. Bivalirudin is a short-acting parenteral direct thrombin inhibitor, typically used during PCI.
What this interaction means in plain words
Apixaban and Bivalirudin 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.
Why it happens
Additive anticoagulant effects via factor Xa and thrombin inhibition.
What to do
Hold apixaban around bivalirudin use as per procedural protocols; monitor for bleeding.
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
- Apixaban 1 mg/1 ml Oral suspension - SmPC sections 4.3/4.5 (class statement: any other anticoagulants; "Due to an increased bleeding risk, concomitant treatment with any other anticoagulants is contraindicated except under specific circumstances of switching antic") — electronic medicines compendium (UK SmPC)
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 Apixaban with Bivalirudin?
MediHelp rates the interaction as major. Apixaban and Bivalirudin 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. Both agents inhibit coagulation, so combined use raises the risk of bleeding. Bivalirudin is a short-acting parenteral direct thrombin inhibitor, typically used during PCI.
How serious is the interaction between Apixaban and Bivalirudin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Hold apixaban around bivalirudin use as per procedural protocols; monitor for bleeding.
What other medicines interact with Apixaban?
MediHelp also lists interactions of Apixaban with, for example, Dabigatran, Defibrotide, Edoxaban. The full list is on the Apixaban page.
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