Apixaban × Celecoxib

Apixaban is a direct factor Xa inhibitor, and NSAIDs, including celecoxib, usually increase bleeding risk (apixaban SmPC). Celecoxib has no antiplatelet effect of its own, but it can cause upper gastrointestinal ulcers and bleeding, sometimes fatal (celecoxib SmPC). With an anticoagulant the risks add up.

Gum bleeding, nosebleeds, bruising without injury, black or tarry stools, blood in the urine. Gastrointestinal complications are more likely in older patients, with a history of ulcer or gastrointestinal bleeding, with alcohol use and with glucocorticoids (celecoxib SmPC).

The combination is allowed with caution: both the apixaban SmPC (EMA) and the Spanish celecoxib SmPC, which names apixaban directly, require it (apixaban SmPC, EMA; celecoxib SmPC). Give celecoxib at the lowest effective daily dose for the shortest possible time and review the need for it regularly (celecoxib SmPC). Take particular care in older patients, in those with a history of ulcer or gastrointestinal bleeding, and in those who drink alcohol or take glucocorticoids or antiplatelet drugs (celecoxib SmPC). The US apixaban label asks doctors to explain the signs of blood loss and to tell patients to report them at once; apixaban is stopped in active pathological bleeding (US apixaban label).