Major
acetylsalicylic acid × apixaban
Antiplatelet agents (low dose) / NSAIDs (analgesic dose)×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Additive antithrombotic action: apixaban + aspirin increases major bleeding risk roughly 1.5–2-fold. For most AF patients, aspirin on top of a DOAC is not justified.
Management
If a patient has AF plus stable CAD or ACS more than 12 months ago, discontinue aspirin and keep only apixaban. Continue aspirin (75–81 mg) only with recent ACS or stenting as part of time-limited dual/triple therapy.
Sources
- AUGUSTUS Investigators: Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation (2019)— N Engl J Med 2019;380(16):1509–1524
- ESC: 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the EACTS (2024)— Eur Heart J 2024;45(36):3314–3414