apixaban and aspirin

Apixaban inhibits factor Xa, while aspirin irreversibly inhibits cyclooxygenase-1, reducing thromboxane A2 synthesis. Combined use results in additive impairment of haemostasis and an increased risk of bleeding.

Co-administration increases the risk of major bleeding, particularly gastrointestinal bleeding, compared with either agent alone. This is of particular concern in patients with additional risk factors such as age, renal impairment, or a history of bleeding.

Avoid co-prescription unless there is a clear indication for both. If used together, use the lowest effective doses, consider gastroprotection with a proton pump inhibitor, and monitor for signs of bleeding. Review the need for antiplatelet therapy regularly.

Well established from clinical trials and meta-analyses of anticoagulant and antiplatelet combination therapy; formal recommendations exist in major cardiology and haematology guidelines.