Apixaban × celecoxib

The selective COX-2 inhibitor celecoxib gives lower GI risk than non-selective NSAIDs, but with a direct factor Xa inhibitor additive bleeding risk persists.

Gum bleeding, epistaxis, bruising without trauma, black or tarry stools, haematuria. Higher risk in older patients, prior peptic ulcer disease, and chronic kidney disease.

Short courses (3–7 days) for pain control are acceptable. For arthritis, avoid long-term celecoxib — consider topical NSAIDs, paracetamol up to 2 g/day, and physiotherapy. In patients over 75 or with creatinine clearance below 50 mL/min, gastroprotection is mandatory.