Drug interactions
Acetylsalicylic acid + Rivaroxaban
Severity: Major
Acetylsalicylic acid and Rivaroxaban: 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
Adding aspirin to rivaroxaban increases the risk of major and minor bleeding. The combination is sometimes intended in cardiovascular disease but carries a clear bleeding penalty.
What this interaction means in plain words
Acetylsalicylic acid and Rivaroxaban 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; Rivaroxaban belongs to Cardiovascular.
Why it happens
Aspirin inhibits platelet aggregation while rivaroxaban inhibits factor Xa, giving additive hemostatic impairment.
What to do
Use the combination only when there is a clear indication, with the lowest aspirin dose and consider PPI cover. Monitor for bleeding and hemoglobin, and avoid higher-dose chronic 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 Rivaroxaban
- Defibrotide + Rivaroxaban Contraindicated
- Ketoconazole + Rivaroxaban Contraindicated
- Ketorolac + Rivaroxaban Contraindicated
- Abciximab + Rivaroxaban Major
- Acalabrutinib + Rivaroxaban Major
- Alteplase + Rivaroxaban Major
Frequently asked questions
Can I take Acetylsalicylic acid with Rivaroxaban?
MediHelp rates the interaction as major. Acetylsalicylic acid and Rivaroxaban 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. Adding aspirin to rivaroxaban increases the risk of major and minor bleeding. The combination is sometimes intended in cardiovascular disease but carries a clear bleeding penalty.
How serious is the interaction between Acetylsalicylic acid and Rivaroxaban?
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, with the lowest aspirin dose and consider PPI cover. Monitor for bleeding and hemoglobin, and avoid higher-dose chronic 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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