Can a patient take Aggrenox (Aspirin and Dipyridamole) and Eliquis (Apixaban) together?

Concurrent Use of Aggrenox and Eliquis

Concurrent use of Aggrenox (aspirin/dipyridamole) and Eliquis (apixaban) is not recommended due to significantly increased bleeding risk without additional proven benefit for stroke prevention.

Understanding the Medications

• Aggrenox is a combination of aspirin (25mg) and extended-release dipyridamole (200mg) that works as an antiplatelet agent primarily used for secondary stroke prevention 1, 2
• Eliquis (apixaban) is an anticoagulant that prevents stroke in patients with atrial fibrillation by inhibiting clot formation 3

Rationale Against Combination Therapy

Increased Bleeding Risk

• The combination of antiplatelet therapy with anticoagulation significantly increases the risk of major bleeding events 1
• Even the combination of aspirin with clopidogrel (both antiplatelet agents) increases life-threatening bleeding by 1.3% absolute risk compared to single antiplatelet therapy 1
• The risk of hemorrhagic complications would be even greater when combining an anticoagulant (Eliquis) with a dual antiplatelet agent (Aggrenox) 1

Lack of Additional Benefit

• Guidelines clearly state that anticoagulation therapy for secondary stroke prevention should not be routinely combined with antiplatelet therapy as there is no evidence of additional benefits over using either therapy alone 1
• For patients with non-cardioembolic ischemic stroke or TIA, antiplatelet agents rather than oral anticoagulation are recommended 1
• For patients with cardioembolic stroke (such as from atrial fibrillation), anticoagulation alone is the standard of care 1

Clinical Decision Algorithm

1. For patients with atrial fibrillation and history of stroke/TIA:

   • Anticoagulation with Eliquis alone is preferred over combination therapy 1
   • Adding antiplatelet therapy to anticoagulation increases bleeding risk without clear additional benefit 1

2. For patients with non-cardioembolic stroke/TIA:

   • Antiplatelet therapy alone (such as Aggrenox) is the recommended treatment 1
   • Adding anticoagulation provides no additional benefit but increases bleeding risk 1

3. For patients with recent coronary stenting AND atrial fibrillation:

   • This is one of the few scenarios where temporary combination therapy might be considered under specialist supervision, but with careful monitoring for bleeding complications 1
   • Even in this scenario, triple therapy (anticoagulant plus dual antiplatelet) should be limited to the shortest duration possible 1

Common Pitfalls to Avoid

• Assuming that "more is better" for antithrombotic therapy - the increased bleeding risk outweighs potential benefits 1
• Continuing combination therapy longer than necessary after coronary interventions 1
• Failing to reassess the need for each medication regularly 1
• Not considering alternative antiplatelet options (such as single agent clopidogrel) if anticoagulation is required 1

Special Considerations

• If a patient has a stroke while on one antithrombotic agent, guidelines suggest reassessing all vascular risk factors and stroke etiology rather than simply adding another antithrombotic agent 1
• For patients who cannot tolerate aspirin, clopidogrel alone is recommended rather than combination therapy 1
• Medication adherence is critical for stroke prevention - complex regimens with multiple antithrombotic agents may reduce compliance 1