Major
Apixaban × Ibuprofen
Direct oral anticoagulants (factor Xa inhibitors)×Non-steroidal anti-inflammatory drugs (NSAIDs)
Mechanism
Apixaban inhibits factor Xa; ibuprofen (NSAID) injures the gastric mucosa and transiently inhibits platelet aggregation. The GI bleeding risk is additive.
Symptoms
Gum bleeding, epistaxis, bruising without trauma, blood in urine or stool, menorrhagia. Severe cases include gastrointestinal or intracranial haemorrhage. Risk rises in patients over 65 and with prior peptic ulcer disease.
Management
Avoid where possible. If a short ibuprofen course is needed, use the minimum effective dose for no more than 5–7 days under pantoprazole cover. For chronic analgesia, choose paracetamol, a selective COX-2 inhibitor (celecoxib), or topical NSAIDs.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.