Acetylsalicylic acid × Apixaban

Aspirin irreversibly blocks platelet cyclooxygenase; apixaban directly inhibits factor Xa. Dual antithrombotic action roughly doubles major bleeding risk versus apixaban alone.

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.

Combine only for strict indications: after coronary stenting or in acute coronary syndrome. Limit aspirin to 75–100 mg/day, and dual therapy to 1–6 months. PPI cover with pantoprazole is mandatory.