Major
Acetylsalicylic acid × Rivaroxaban
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Aspirin irreversibly blocks platelet cyclooxygenase; rivaroxaban directly inhibits factor Xa. Dual antithrombotic action raises major bleeding risk roughly 1.5- to 2-fold versus rivaroxaban alone.
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
Combine only for strict indications. Limit aspirin to 75–100 mg/day and dual therapy to 1–6 months. PPI cover with pantoprazole is mandatory.